Compass Health, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Columbia, MO
NPI 1316617186 · NPPES record last updated Sep 14, 2021
Key facts
- NPI
- 1316617186
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- COMPASS HEALTH, INC
- Practice address
- 1705 E Broadway Ste 340
Columbia, MO 65201-7167 - Phone
- (844) 853-8937
- NPI assigned
- Sep 14, 2021
- Organization subpart
- No
Authorized official
- Name
- Teresa L Porter
- Title
- Credentialing & Contracting Manager
- Phone
- (660) 890-8156
Corporate family (same tax ID) 24
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 26D2333881 | Compass Health - Columbia East Broadway | Certificate of waiver | Nov 11, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Federally qualified health center certification: CCN 791165
- Legal name
- COMPASS HEALTH INC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Sep 22, 2021
- Last certification
- Sep 22, 2021
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Nov 26, 1974 in MO
- Enrollment address
- 1705 E Broadway
Ste 340
Columbia, MO 65201-7167
All disclosed owners & managing parties 10
| Name | Role | Since | Share |
|---|---|---|---|
| Joi Niedner |
Other |
Jun 16, 2021 | |
| Dennis Daugherty |
Other |
Jun 16, 2021 | |
| Rodney Reid |
Other |
Jun 16, 2021 | |
| Teresa L Porter |
W-2 Managing Employee |
Jun 16, 2021 | |
| Keith Schafer |
Other |
Jun 16, 2021 | |
| Curtis Cain |
Other |
Jun 16, 2021 | |
| Tim Glasscock |
Other |
Jun 16, 2021 | |
| Brian C Baker |
Other |
Jun 16, 2021 | |
| Tim Alan Larimore |
Other |
Jun 16, 2021 | |
| Alan W Stevens |
Corporate Director |
Jun 16, 2021 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Compass Health Inc |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Jul 11, 2018 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210923001105 | MO | Part a Provider - Federally Qualified Health Center (FQHC) | 1951206754 | Practice locations: Columbia, MO |
National Provider Directory
- Tax ID family
- Pathways Community Beha
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
1705 E Broadway Ste 340
Columbia, MO 65201-7167
Mailing address
1800 Community
Clinton, MO 64735-8804
Phone (660) 890-8156
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All providers in Columbia, 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 Sep 14, 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.