NPIMap

Organization Active NPI

Northwest Health Services, Inc

  • Federally Qualified Health Center (FQHC)
  • Saint Joseph, MO
National Provider Identifier
1629190822
Registry record updated Nov 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NORTHWEST HEALTH SERVICES, INC
Practice address
2303 Village Dr
Saint Joseph, MO 64506-4954
Phone
(816) 232-6818
Fax
(816) 232-6823
NPI assigned
Apr 6, 2007
Organization subpart
No

Authorized official

NPPES NPI Registry
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.

View all 16

Other NPIs with the same Medicare PAC ID 14

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

View all 14

Facilities connected through Provider of Services related, parent or unit certification numbers.

Practitioners 23

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

View all 23

Medicare participation

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

Enrollment records 2

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…
O20080731000558 MO Part a Provider - Federally Qualified Health Center (FQHC) 7113835174 Practice locations: Saint Joseph, MO

Federally qualified health center certification: CCN 261845

Medicare enrollment files
Legal name
NORTHWEST HEALTH SERVICES INC
Doing business as
FAMILY MEDICINE ASSOCIATES
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 1, 1998
Last certification
Feb 1, 1998
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
May 1, 1983 in MO
Enrollment address
2303 Village Dr
Saint Joseph, MO 64506-4954

All disclosed owners & managing parties 6

Medicare enrollment files

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

NameRoleSinceShare
Kimberly Ireland Individual Corporate DirectorBoard of Directors Vice President Mar 2, 2010 100%
Whitney Lanning Individual Corporate DirectorBoard of Directors President Jan 1, 2020 100%
Steve Loucks Individual Corporate DirectorBoard Member Jan 1, 2014 100%
Carolyn Hall Individual Corporate DirectorBoard of Directors Secretary Jan 1, 2020 100%
Tina R Taylor Individual Corporate OfficerCfo Mar 1, 2016 100%
W-2 Managing EmployeeCfo Mar 1, 2016 100%
Robin Moppin Individual W-2 Managing EmployeeBilling & Coding Manager Feb 1, 2020 100%
Operational/Managerial ControlBilling & Coding Manager Feb 1, 2020 100%

National Provider Directory

National Provider Directory
Tax ID family
Family Medicin E a21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

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

View all 20

Locations

503 S 6th St
Saint Joseph, MO 64501
Phone (816) 233-5188

Specialties & licenses 3

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

NPPES NPI Registry

Primary practice location

2303 Village Dr
Saint Joseph, MO 64506-4954

Mailing address

2303 Village Dr
Saint Joseph, MO 64506-4954
Phone (816) 232-6818

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
509712501MedicaidMO

Other names 1

NPPES NPI Registry
  • Family Medicine Associates Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 10, 2021.

{
    "created_epoch": "1175817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636502400000",
    "number": "1629190822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2303 VILLAGE DR",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645064954",
            "telephone_number": "816-232-6818",
            "fax_number": "816-232-6823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2303 VILLAGE DR",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645064954",
            "telephone_number": "816-232-6818",
            "fax_number": "816-232-6823"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST HEALTH SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-06",
        "last_updated": "2021-11-10",
        "certification_date": "2021-11-10",
        "status": "A",
        "authorized_official_last_name": "YOUNGER",
        "authorized_official_first_name": "MATT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "816-232-6818"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "509712501",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Medicine Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Family Medicine Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Joseph, MO

Sources for this page

Verify at the official NPI Registry.