NPIMap

Organization Active NPI

Success Health System, LLC

  • Psychiatry Physician
  • Columbia, MO
National Provider Identifier
1508310293
Registry record updated Sep 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
SUCCESS HEALTH SYSTEM, LLC
Practice address
3600 Interstate 70 Dr SE Ste C
Columbia, MO 65201-6583
Phone
(888) 410-5230
NPI assigned
Aug 10, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2025

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

Authorized official

Name
Mr. Moses Tabe Ambilichu, M.D.
Title
MD
Phone
(972) 974-0109

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

3600 Interstate 70 Dr SE Ste C
Columbia, MO 65201-6583

Mailing address

PO Box 716
Columbia, MO 65205-0716
Phone (972) 974-0109

Other practice location 1

2010 S Buckner Blvd
Dallas, TX 75217-1804
Phone (888) 410-5230

Other practice location 2

12401 Olive Blvd Ste 206
Creve Coeur, MO 63141-5448
Phone (888) 410-5230

Other practice location 3

4429 S River Blvd Ste D
Independence, MO 64055-4659
Phone (888) 410-5230

Other practice location 4

11695 S Blackbob Rd
Olathe, KS 66062-1058
Phone (888) 410-5230

Other practice location 5

3400 Chapel Hill Rd
Douglasville, GA 30135-1739
Phone (888) 410-5230

Other practice location 6

2805 E 19th St
Vancouver, WA 98661-4614
Phone (888) 410-5230

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, KS, TX, GA4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20170316000937 MO Part B Supplier - Clinic/Group Practice 2961787809 Receives reassigned benefits from 17 practitioners
Practice locations: Columbia, MO; Creve Coeur, MO; Independence, MO
O20170526001310 KS Part B Supplier - Clinic/Group Practice 2961787809 Receives reassigned benefits from 17 practitioners
Practice locations: Olathe, KS
O20230320001357 TX Part B Supplier - Clinic/Group Practice 2961787809 Receives reassigned benefits from 2 practitioners
Practice locations: Garland, TX
O20240718004539 GA Part B Supplier - Clinic/Group Practice 2961787809 Receives reassigned benefits from 1 practitioner
Practice locations: Douglasville, GA

National Provider Directory

National Provider Directory

Locations

2300 Hutton Rd
Kansas City, KS 66109
Phone (913) 207-7674

2804 Forum Blvd
Columbia, MO 65203
Phone (573) 446-4949

3600 Interstate 70 Dr SE
Ste C
Columbia, MO 65201

4429 S River Blvd
Ste D
Independence, MO 64055
Phone (816) 373-0200

2709 Industrial Dr
Ste A
Jefferson Cty, MO 65109
Phone (573) 635-2141

2010 S Buckner Blvd
Dallas, TX 75217

714 S Jupiter Rd
Ste A
Garland, TX 75042

Practitioners & affiliated clinicians

Practitioners 33

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

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1470787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759190400000",
    "number": "1508310293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 716",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652050716",
            "telephone_number": "972-974-0109",
            "fax_number": "573-271-5108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 INTERSTATE 70 DR SE STE C",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652016583",
            "telephone_number": "888-410-5230"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2010 S Buckner Blvd",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "752171804",
            "country_code": "US",
            "telephone_number": "888-410-5230",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12401 Olive Blvd Ste 206",
            "address_purpose": "LOCATION",
            "city": "Creve Coeur",
            "state": "MO",
            "postal_code": "631415448",
            "country_code": "US",
            "telephone_number": "888-410-5230",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4429 S River Blvd Ste D",
            "address_purpose": "LOCATION",
            "city": "Independence",
            "state": "MO",
            "postal_code": "640554659",
            "country_code": "US",
            "telephone_number": "888-410-5230",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11695 S Blackbob Rd",
            "address_purpose": "LOCATION",
            "city": "Olathe",
            "state": "KS",
            "postal_code": "660621058",
            "country_code": "US",
            "telephone_number": "888-410-5230",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3400 Chapel Hill Rd",
            "address_purpose": "LOCATION",
            "city": "Douglasville",
            "state": "GA",
            "postal_code": "301351739",
            "country_code": "US",
            "telephone_number": "888-410-5230",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2805 E 19th St",
            "address_purpose": "LOCATION",
            "city": "Vancouver",
            "state": "WA",
            "postal_code": "986614614",
            "country_code": "US",
            "telephone_number": "888-410-5230",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SUCCESS HEALTH SYSTEM, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-10",
        "last_updated": "2025-09-30",
        "certification_date": "2025-09-30",
        "status": "A",
        "authorized_official_last_name": "AMBILICHU",
        "authorized_official_first_name": "MOSES",
        "authorized_official_middle_name": "TABE",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "972-974-0109",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.