NPIMap

Organization Active NPI

Infinity Health

  • Federally Qualified Health Center (FQHC)
  • Bethany, MO
National Provider Identifier
1699334805
Registry record updated Feb 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
INFINITY HEALTH
Practice address
2600 Miller St
Bethany, MO 64424-2701
Phone
(414) 462-3836
NPI assigned
Jun 11, 2019
Last updated
Feb 11, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
INFINITY HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 11, 2022

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

Authorized official

Name
Samantha Cannon
Title
Ceo
Phone
(641) 446-2383

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

2600 Miller St
Bethany, MO 64424-2701

Mailing address

302 NE 14TH St
Leon, IA 50144-1206
Phone (641) 446-2383

Other identifiers 2

IdentifierTypeStateIssuer
0462887MedicaidIA
507202208MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190715002064 MO Part A Provider - Federally Qualified Health Center (FQHC) 5597717496 Practice locations: Bethany, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1699334805. Details of each certification follow.

Federally qualified health center certification: CCN 261171

Legal name
INFINITY HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 10, 2019
Last certification
Jul 10, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 17, 1997 in IA
Enrollment address
2600 Miller St
Bethany, MO 64424-2701

Other NPIs with the same Medicare PAC ID 11

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

National Provider Directory

National Provider Directory
Tax ID family
Infinity Health13 organizations share this tax ID, including this one
Part of
Infinity Health

Other organizations with this tax ID 12

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

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Justin James Akers Individual Corporate DirectorBoard Treasurer Aug 22, 2017 10%
Rachel Cecil Individual Corporate Director Mar 26, 2019 10%
Shirley Kessel Individual Corporate Director Jan 1, 2005 10%
Jonathan Erb Individual Corporate Director Sep 24, 2019 10%
Alan Wilson Individual Corporate Director Mar 23, 2010 10%
William Morain Individual Corporate Director Jan 1, 2005 10%
Marcy Biesemeyer Individual Corporate Director Apr 22, 2014 10%
Dien Judge Individual Corporate Director Oct 28, 2014 10%
Kyle E Ahlenstorf Individual Corporate OfficerCeo Dec 27, 2023
Corporate DirectorCeo Dec 27, 2023
W-2 Managing EmployeeCeo Dec 27, 2023
Operational/Managerial ControlCeo Dec 27, 2023
Linda Baynes Individual Corporate Director May 22, 2018 10%
Alan Dykens Individual Corporate Director Jan 24, 2017 10%

NPI Registry JSON

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

{
    "created_epoch": "1560211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644537600000",
    "number": "1699334805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 NE 14TH ST",
            "city": "LEON",
            "state": "IA",
            "postal_code": "501441206",
            "telephone_number": "641-446-2383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 MILLER ST",
            "city": "BETHANY",
            "state": "MO",
            "postal_code": "644242701",
            "telephone_number": "414-462-3836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INFINITY HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INFINITY HEALTH",
        "enumeration_date": "2019-06-11",
        "last_updated": "2022-02-11",
        "certification_date": "2022-02-11",
        "status": "A",
        "authorized_official_last_name": "CANNON",
        "authorized_official_first_name": "SAMANTHA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "641-446-2383"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0462887",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "507202208",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bethany, MO

Sources for this page

Verify at the official NPI Registry.