NPIMap

Organization Active NPI

Carestl Health

  • Federally Qualified Health Center (FQHC)
  • Saint Louis, MO
National Provider Identifier
1609245448
Registry record updated Jun 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CARESTL HEALTH
Practice address
4500 Pope Ave
Saint Louis, MO 63115-2512
Phone
(314) 367-5820
Fax
(314) 367-7010
NPI assigned
Sep 23, 2015
Last updated
Jun 27, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2018

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

Authorized official

Name
Mrs. Angela Renee Archibald-Clabon
Title
Ceo
Phone
(314) 367-5820

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

4500 Pope Ave
Saint Louis, MO 63115-2512

Mailing address

PO Box
Chicago, IL 60677-0271
Phone (314) 898-1268

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
This NPI is an additional NPI on the enrollment
Practice locations: Jennings, MO; Saint Louis, MO; Saint Ann, MO
O20161005000133 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 1609245448. Details of each certification follow.

Federally qualified health center certification: CCN 261123

Legal name
CARESTL HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 4, 2016
Last certification
Oct 4, 2016
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Oct 17, 1969 in MO
Enrollment address
4500 Pope Ave
Saint Louis, MO 63115-2512

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 Apr 27, 2023
Eva Marie Aagaard Individual Corporate Director Apr 27, 2023
Randi Foraker Individual Corporate Director Apr 27, 2023
Latrell Hayes Individual Corporate Director Apr 27, 2023
Darrell Hudson Individual Corporate Director Apr 27, 2023
Saint Rice Individual Corporate Director Apr 27, 2023
Tiffany Paul Individual Corporate Director Apr 27, 2023
Sheila Stuart Individual Corporate Director Apr 27, 2023
Vida Paul-Perry Individual Corporate Director Apr 27, 2023
Bonnie Woods Individual Corporate Director Apr 27, 2023
Flora Robinson Individual Corporate Director Apr 27, 2023
Chrisena Brown Individual Corporate Director Apr 27, 2023
Karen Jones Individual Corporate Director Apr 27, 2023
Angela Archibald-Clabon Individual Corporate OfficerChief Executive Officer Dec 17, 2013 100%
W-2 Managing EmployeeChief Executive Officer Dec 17, 2013 100%
Dara Webb Individual Corporate Director Apr 27, 2023
Aaron Craig Individual Corporate Director Apr 27, 2023

Owners & managing parties with NPI records 1

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

NPI Registry JSON

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

{
    "created_epoch": "1442966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1530057600000",
    "number": "1609245448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606770271",
            "telephone_number": "314-898-1268",
            "fax_number": "855-298-7184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 POPE AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631152512",
            "telephone_number": "314-367-5820",
            "fax_number": "314-367-7010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARESTL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-23",
        "last_updated": "2018-06-27",
        "status": "A",
        "authorized_official_last_name": "ARCHIBALD-CLABON",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "314-367-5820",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.