NPIMap

Organization Active NPI

Kansas City Care Clinic

Doing business as KC CARE Health

  • Federally Qualified Health Center (FQHC)
  • Kansas City, MO
National Provider Identifier
1396101317
Registry record updated Sep 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
KANSAS CITY CARE CLINIC
Doing business as
KC CARE Health
KC CARE Health Center
Practice address
2340 E Meyer Blvd Ste 208
Kansas City, MO 64132-1121
Phone
(816) 753-5144
Fax
(855) 737-0585
NPI assigned
Jan 6, 2016
Last updated
Sep 21, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
KANSAS CITY CARE CLINICAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 21, 2022

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

Authorized official

Name
Debbie Skaggs
Title
Director of Credentialing
Phone
(816) 777-2761

Specialties & licenses 1

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

Addresses

Primary practice location

2340 E Meyer Blvd Ste 208
Kansas City, MO 64132-1121

Mailing address

3515 Broadway Blvd
Kansas City, MO 64111-2501
Phone (816) 753-5144

Other practice location 1

2340 E Meyer Blvd Ste 200
Kansas City, MO 64132-1121
Phone (816) 753-5144

Other identifiers 1

IdentifierTypeStateIssuer
500029376MedicaidMO

Other names 2

  • KC CARE Health Doing business as
  • KC CARE Health Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL eCW

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130514000624 MO Part B Supplier - Clinic/Group Practice 9335386168 Receives reassigned benefits from 34 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kansas City, MO
O20160314000532 MO Part A Provider - Federally Qualified Health Center (FQHC) 9335386168 Practice locations: Kansas City, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1396101317. Details of each certification follow.

Federally qualified health center certification: CCN 261117

Legal name
KANSAS CITY CARE CLINIC
Doing business as
KC CARE HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 10, 2016
Last certification
Mar 10, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 14, 1971 in MO
Enrollment address
2340 E Meyer Blvd Ste 200
Kansas City, MO 64132-1121

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Part of
Kansas City Care Clinic

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

3515 Broadway Blvd
Kansas City, MO 64111
Phone (816) 753-5144

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Thomas Wilson Franklin Individual Corporate OfficerPresident and Ceo May 2, 2019
George Albert Barreto Individual Corporate OfficerChief Financial Officer Sep 21, 2016
Bernard Malone Individual Corporate DirectorBoard Member Apr 1, 2016
Thomas Nagel Individual Corporate DirectorBoard Member Jun 28, 2016
Dennis Dunmyer Individual W-2 Managing EmployeeChief Operating Officer Nov 6, 2009
Kansas City Care Clinic Organization, Kansas City, MO Corporation, Non-profit Operational/Managerial Control Apr 14, 1971
Nikki Beard Individual Corporate DirectorBoard Member Aug 1, 2015

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
KC Care Health CenterKansas City, MO, CCN 261108 Federally qualified health center Operational/Managerial Control Apr 14, 1971

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1452038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663718400000",
    "number": "1396101317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3515 BROADWAY BLVD",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641112501",
            "telephone_number": "816-753-5144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2340 E MEYER BLVD STE 208",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641321121",
            "telephone_number": "816-753-5144",
            "fax_number": "855-737-0585"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2340 E Meyer Blvd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Kansas City",
            "state": "MO",
            "postal_code": "641321121",
            "country_code": "US",
            "telephone_number": "816-753-5144",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KANSAS CITY CARE CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KANSAS CITY CARE CLINIC",
        "enumeration_date": "2016-01-06",
        "last_updated": "2022-09-21",
        "certification_date": "2022-09-21",
        "status": "A",
        "authorized_official_last_name": "SKAGGS",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "816-777-2761"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500029376",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "eCW",
            "affiliation": "N",
            "address_1": "2340 E Meyer Blvd Ste 200&208",
            "city": "Kansas City",
            "state": "MO",
            "country_code": "US",
            "postal_code": "641321105",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "KC CARE Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "KC CARE Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kansas City, MO

Sources for this page

Verify at the official NPI Registry.