Northwest Health Services Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Braymer, MO
NPI 1215059209 · NPPES record last updated Nov 10, 2021
Key facts
- NPI
- 1215059209
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- NORTHWEST HEALTH SERVICES INC
- Practice address
- 109 Main Street
Braymer, MO 64624 - Phone
- (660) 645-2218
- Fax
- (660) 645-2820
- NPI assigned
- Apr 3, 2007
- Organization subpart
- No
Authorized official
- Name
- Matt Younger
- Title
- Ceo
- Phone
- (816) 232-6818
Other NPIs on the same Medicare enrollment 16
Other NPIs with the same Medicare PAC ID 14
Practitioners 20
-
Caitlin Joan Colescott, FNP-C
-
Megan Cordova, FNP-BC
-
Sarah Ann Findley, FNP
-
William V Irby, DO
-
Brittany Shea McCan, FNP-BC
-
Krikor O. Partamian, M.D.
-
Linsey Pflugradt, APRN FNP
-
Elizabeth Renshaw, FNP
-
Donald Wayne Hinton, M.D.
-
Barbara D McCullough, FNP-C
-
Jessica Nicole Whiteman, APRN
-
Jessica Fultz, FNP-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 26D0680642 | Northwest Health Services Inc | Certificate of waiver | Feb 5, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MO
Federally qualified health center certification: CCN 261817
- Legal name
- NORTHWEST HEALTH SERVICES INC
- Doing business as
- BRAYMER CLINIC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Oct 1, 1991
- Last certification
- Oct 1, 1991
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- May 1, 1983 in MO
- Enrollment address
- 109 Main St
Braymer, MO 64624-9325
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Alan Mulnix |
Corporate Officer |
Jan 1, 2014 | 100% |
| Corporate Director |
Jan 1, 2014 | 100% | |
| Kimberly Ireland |
Corporate Officer |
Jul 8, 2008 | 100% |
| Corporate Director |
Jul 8, 2008 | 100% | |
| Denise K Jennings |
Corporate Officer |
Mar 1, 2021 | 100% |
| Jennifer McKinley |
Corporate Officer | Jun 1, 2019 | 100% |
| Terry Steinbecker |
Corporate Officer |
Jul 8, 2008 | 100% |
| Corporate Director |
Jul 8, 2008 | 100% | |
| Elizabeth Blakley |
Corporate Officer |
Jul 8, 2008 | 100% |
| Corporate Director |
Jul 8, 2008 | 100% | |
| Kevin Haywood |
Corporate Officer | Dec 1, 2021 | 100% |
| Lanny Ellis |
Corporate Officer | Mar 1, 2021 | 100% |
| Leslie Phillips |
Corporate Officer | Jun 1, 2018 | 100% |
| Steve Loucks |
Corporate Officer |
Jan 1, 2014 | 100% |
| Corporate Director |
Jan 1, 2014 | 100% | |
| Sherry Weldon |
Corporate Officer | Jun 1, 2019 | 100% |
| Tina R Taylor |
Corporate Officer | Aug 29, 2008 | 100% |
| Corporate Director |
Mar 1, 2016 | 100% | |
| W-2 Managing Employee |
Mar 1, 2016 | 100% | |
| Robin Moppin |
W-2 Managing Employee |
Feb 1, 2020 | 100% |
| Operational/Managerial Control |
Feb 1, 2020 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040720001347 | MO | Part B Supplier - Clinic/Group Practice | 7113835174 |
Receives reassigned benefits from 24 practitioners 16 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Gower, MO; Savannah, MO; Saint Joseph, MO; King City, MO; Hamilton, MO; Braymer, MO; Chillicothe, MO; Cainsville, MO… |
| O20080731000512 | MO | Part a Provider - Federally Qualified Health Center (FQHC) | 7113835174 | Practice locations: Braymer, MO |
National Provider Directory
Locations
109 N Main St
Braymer, MO 64624
Phone (660) 234-3090
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
109 Main Street
Braymer, MO 64624
Mailing address
109 Main Street
Braymer, MO 64624-0036
Phone (660) 645-2218
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 501330435 | Medicaid | MO |
Other names
- Braymer Clinic
Other providers in Braymer, MO
- Harlie Mayson Crowe
- Sarah Ann Findley
- Golden Age Nursing Home District
- Cailyn Ranae Haley
- Dorothy Milburn
- Daniel Scott Pennington
- Hillary Marie Simpson
All providers in Braymer, MO · Federally Qualified Health Center (FQHC) in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 10, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.