NPIMap

Organization Active NPI

Carestl Health

Doing business as Homer G. Phillips Health Center

  • Federally Qualified Health Center (FQHC)
  • Saint Louis, MO
National Provider Identifier
1376685529
Registry record updated Sep 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CARESTL HEALTH
Doing business as
Homer G. Phillips Health Center
Practice address
2425 Whittier St
Saint Louis, MO 63113-2950
Phone
(314) 371-3100
Fax
(314) 289-8718
NPI assigned
Feb 13, 2007
Last updated
Sep 26, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Angela R Clabon, MBA
Title
Ceo
Phone
(314) 367-5820

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X MO Primary

Addresses

Primary practice location

2425 Whittier St
Saint Louis, MO 63113-2950

Mailing address

2425 Whittier St
Saint Louis, MO 63113-2950
Phone (314) 367-5820

Other identifiers 1

IdentifierTypeStateIssuer
507523702MedicaidMO

Other names 1

  • Homer G. Phillips Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031219000441 MO Part B Supplier - Clinic/Group Practice 1557269289 Receives reassigned benefits from 42 practitioners
13 other NPIs on this enrollment
Practice locations: Jennings, MO; Saint Louis, MO; Saint Ann, MO
O20100616000796 MO Part A Provider - Federally Qualified Health Center (FQHC) 1557269289 Practice locations: Saint Louis, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1376685529. Details of each certification follow.

Federally qualified health center certification: CCN 261894

Legal name
CARESTL HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 8, 2005
Last certification
Nov 8, 2005
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
in MO
Enrollment address
2425 Whittier St
Saint Louis, MO 63113-2950
Related CCNs
261808

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 13

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 13

National Provider Directory

National Provider Directory
Tax ID family
St Louis Comp Health CT23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

Organizations that report the same tax identification number in the National Provider Directory.

View all 22

Ownership & related parties

All disclosed owners & managing parties 16

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
William Dailey Individual Corporate Director Jan 1, 2023
Eva Marie Aagaard Individual Corporate Director Jan 1, 2023
Randi Foraker Individual Corporate Director Jan 1, 2023
Latrell Hayes Individual Corporate Director Jan 1, 2023
Darrell Hudson Individual Corporate Officer Jan 1, 2023
Saint Rice Individual Corporate Officer Jan 1, 2023
Tiffany Paul Individual Corporate OfficerBoard Vice Chairperson Jan 1, 2023
Sheila Stuart Individual Corporate Officer Jan 1, 2023
Vida Paul-Perry Individual Corporate OfficerBoard Secretary Jan 1, 2023
Bonnie Woods Individual Corporate Officer Jan 1, 2023
Flora Robinson Individual Corporate Officer Jan 1, 2023
Chrisena Brown Individual Corporate OfficerTreasurer Jan 1, 2023
Karen Jones Individual Corporate OfficerBoard Chairperson Jan 1, 2023
Angela Archibald-Clabon Individual Corporate OfficerCeo Dec 18, 2013 100%
Corporate DirectorCeo Dec 18, 2013 10%
W-2 Managing EmployeeCeo Dec 18, 2013 100%
Dara Webb Individual Corporate Officer Jan 1, 2023
Aaron Craig Individual Corporate Director Jan 1, 2023

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 44

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 44

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1537920000000",
    "number": "1376685529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2425 WHITTIER ST",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631132950",
            "telephone_number": "314-367-5820",
            "fax_number": "314-367-7010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2425 WHITTIER ST",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631132950",
            "telephone_number": "314-371-3100",
            "fax_number": "314-289-8718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARESTL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-13",
        "last_updated": "2018-09-26",
        "status": "A",
        "authorized_official_last_name": "CLABON",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "314-367-5820",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "507523702",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Homer G. Phillips Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Homer G. Phillips Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.