NPIMap

Organization Active NPI

Northwest Health Services, Inc

Doing business as Family Medicine Associates

  • 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
Doing business as
Family Medicine Associates
Practice address
2303 Village Dr
Saint Joseph, MO 64506-4954
Phone
(816) 232-6818
Fax
(816) 232-6823
NPI assigned
Apr 6, 2007
Last updated
Nov 10, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2021

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

Authorized official

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

Specialties & licenses 3

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

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 names 1

  • Family Medicine Associates Doing business as

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1629190822. Details of each certification follow.

Federally qualified health center certification: CCN 261845

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

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

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

Other NPIs on the same Medicare enrollment 16

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

View all 16

National Provider Directory

National Provider Directory
Tax ID family
Northwest Health Services21 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

707 Victory Ln
Cainsville, MO 64632
Phone (660) 893-5750

305 Rhode Island St
King City, MO 64463
Phone (660) 535-4347

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

Ownership & related parties

All disclosed owners & managing parties 6

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%

Practitioners & affiliated clinicians

Practitioners 10

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": "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": [],
    "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.