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Northwest Health Services, Inc

Organization Active NPI Federally Qualified Health Center (FQHC) · Gower, MO

NPI 1407360449 · NPPES record last updated Nov 10, 2021

Key facts

NPI
1407360449
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
NORTHWEST HEALTH SERVICES, INC
Practice address
313 S US Highway 169
Gower, MO 64454-9116
Phone
(816) 424-6427
Fax
(816) 416-3387
NPI assigned
Nov 29, 2017
Organization subpart
No

Authorized official

Name
Matt Younger
Title
Ceo
Phone
(816) 232-6818

Other NPIs on the same Medicare enrollment 16

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

Other NPIs with the same Medicare PAC ID 14

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

Corporate family (same tax ID) 20

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

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in MO

Federally qualified health center certification: CCN 261153

Legal name
NORTHWEST HEALTH SERVICES INC
Doing business as
GOWER FAMILY MEDICINE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 15, 2018
Last certification
Jan 15, 2018
Ownership / control type
For profit – corporation
Organization structure
Other · Non-profit
Incorporated
May 1, 1983 in MO
Enrollment address
313 S US Highway 169
Gower, MO 64454-9116

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Tina R Taylor
Individual 		Corporate Officer
Cfo		 Feb 1, 2020 100%
W-2 Managing Employee
Cfo		 Feb 1, 2020 100%
Robin Moppin
Individual 		W-2 Managing Employee
Billing & Coding Manager		 Feb 1, 2020 100%
Operational/Managerial Control
Billing & Coding Manager		 Feb 1, 2020 100%

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
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…
O20180116000670 MO Part a Provider - Federally Qualified Health Center (FQHC) 7113835174 Practice locations: Gower, MO

National Provider Directory

Tax ID family
Family Medicin E a (21 organizations share this tax ID)

Locations

1303 State St
Mound City, MO 64470
Phone (660) 442-5464

5001 Lake Ave
Saint Joseph, MO 64504
Phone (816) 238-7788

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X Yes

Addresses

Primary practice location

313 S US Highway 169
Gower, MO 64454-9116

Mailing address

303 South US Hwy 169
Gower, MO 64454
Phone (816) 424-6427

Other names

  • Gower Family Medicine Doing business as

Other providers in Gower, MO

All providers in Gower, MO · Federally Qualified Health Center (FQHC) in Missouri

Sources for this page

Verify at the official NPI Registry.