Open Cities Health Center, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · St. Paul, MN
NPI 1376769778 · NPPES record last updated Jan 10, 2020
Key facts
- NPI
- 1376769778
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- OPEN CITIES HEALTH CENTER, INC.
- Practice address
- 916 Rice Street
St. Paul, MN 55117-5425 - Phone
- (651) 290-9200
- Fax
- (651) 290-9210
- NPI assigned
- Apr 17, 2007
- Organization subpart
- Yes
- Parent organization (as reported)
- OPEN CITIES HEALTH CENTER, INC.
Authorized official
- Name
- Frances Green
- Title
- HR
- Phone
- (651) 290-2111
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 1
Practitioners 18
-
Diana Arredondo, OD
-
Michael R Kamp, MD
-
Samuel Yaw Boadu, DNP
-
Victoria Hoehn, PA-C
-
Kaitlyn Huebsch Hollenbach, OD, FAAO
-
Chelsea Shirley Johnson, PA-C
-
Nicole Rochelle Terlouw, LICSW
-
Crystal J Ford, LPCC
-
Rachel A Hanus, APRN, CNM
-
Julia P Joseph-Di Caprio, MD, MPH
-
Bruce David McCarthy, M.D.
-
Aszani Stoddard, APRN, CNM, MSN
-
Helen Haewon Kim, DDS
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 24D0399689 | Open Cities Health Center - North End | Certificate of waiver | May 7, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MN
Federally qualified health center certification: CCN 241825
- Legal name
- OPEN CITIES HEALTH CENTER INC
- Doing business as
- OPEN CITIES HEALTH CENTER INC NORTHEND
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Oct 12, 2001
- Last certification
- Oct 12, 2001
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Dec 15, 1981 in MN
- Enrollment address
- 916 Rice St
Saint Paul, MN 55117-5425
All disclosed owners & managing parties 10
| Name | Role | Since | Share |
|---|---|---|---|
| Jamal Lewis |
Corporate Director |
May 1, 2018 | |
| Gabriela Vazquez-Benitez |
Corporate Director |
Jul 1, 2018 | |
| Kee Vang |
Corporate Director |
Nov 1, 2018 | |
| Todd Hurley |
Corporate Director |
Jun 1, 2020 | |
| Thuong Pham |
Corporate Director |
Jan 1, 2021 | |
| Kaade Wallace |
Corporate Director |
Aug 1, 2020 | |
| Ana Diaz |
Corporate Director |
Aug 1, 2016 | |
| Sabrina Salazar |
Corporate Officer |
Oct 14, 2024 | |
| Corporate Director |
Oct 14, 2025 | ||
| W-2 Managing Employee |
Oct 14, 2024 | ||
| Keillen Curtis |
Corporate Director | Aug 1, 1987 | 100% |
| Carolyn Henry |
Contracted Managing Employee | Jul 1, 2021 | |
| Corporate Director | Jul 1, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20030716000029 | MN | Part a Provider - Federally Qualified Health Center (FQHC) | 5799696621 | Practice locations: Saint Paul, MN |
| O20031110000648 | MN | Part B Supplier - Clinic/Group Practice | 5799696621 |
Receives reassigned benefits from 24 practitioners 2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Saint Paul, MN |
National Provider Directory
- Part of
- Model Cities Health Ctr
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Clinic/Center | 261QC1500X | 3432431 | MN | |
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
916 Rice Street
St. Paul, MN 55117-5425
Mailing address
409 N Dunlap Street
St. Paul, MN 55104-4201
Phone (651) 489-8021
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 048695700 | Medicaid | MN |
Other names
- Open Cities Health Center, Inc. - Northend
Other providers in St. Paul, MN
- Joseph M Opack
- Open Arms Care Incorporation
- Open Arms Minnesota
- Open Cities Health Center, Inc.
- Open Cities Health Center, Inc.
- Open Cities Health Center, Inc.
- Open Cities Health Center, Inc.
- Open Cities Health Center, Inc.
- Open Cities Health Center, Inc.
- Open Cities Health Center, Inc. - Rice Street
All providers in St. Paul, MN · Federally Qualified Health Center (FQHC) in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 10, 2020. 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.