NPIMap

Organization Active NPI

Kansas City Care Clinic

Doing business as KC CARE Health Center

  • Federally Qualified Health Center (FQHC)
  • Kansas City, MO
National Provider Identifier
1770024663
Registry record updated Nov 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
KANSAS CITY CARE CLINIC
Doing business as
KC CARE Health Center
Practice address
4601 Independence Ave
Kansas City, MO 64124
Phone
(816) 753-5144
Fax
(816) 753-0804
NPI assigned
Mar 13, 2017
Last updated
Nov 25, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
KANSAS CITY CARE CLINICAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 25, 2020

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

Authorized official

Name
Mr. Thomas Wilson Franklin
Title
President and Ceo
Phone
(816) 777-2763

Specialties & licenses 1

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

Addresses

Primary practice location

4601 Independence Ave
Kansas City, MO 64124

Mailing address

3515 Broadway Blvd
Kansas City, MO 64111-2501
Phone (816) 753-5144

Other identifiers 1

IdentifierTypeStateIssuer
500005358MedicaidMO

Other names 1

  • KC CARE Health Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130514000624 MO Part B Supplier - Clinic/Group Practice 9335386168 Receives reassigned benefits from 34 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kansas City, MO
O20170908002101 MO Part A Provider - Federally Qualified Health Center (FQHC) 9335386168 Practice locations: Kansas City, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1770024663. Details of each certification follow.

Federally qualified health center certification: CCN 261143

Legal name
KANSAS CITY CARE CLINIC
Doing business as
KC CARE HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 8, 2017
Last certification
Sep 8, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 14, 1971 in MO
Enrollment address
4601 Independence Ave
Kansas City, MO 64124-2927

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Part of
Kansas City Care Clinic

Locations

4601 Independence Ave
Kansas City, MO 64124
Phone (816) 241-6334

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
Thomas Wilson Franklin Individual Corporate OfficerPresident and Ceo May 2, 2019
George Albert Barreto Individual Corporate OfficerChief Financial Officer Sep 21, 2016
Bernard Malone Individual Corporate DirectorBoard Member Apr 1, 2016
Thomas Nagel Individual Corporate DirectorBoard Member Jun 26, 2016
Dennis Dunmyer Individual W-2 Managing EmployeeChief Operations Officer Nov 6, 2009
Nikki Beard Individual Corporate DirectorBoard Member Apr 1, 2016

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
KC Care Health CenterKansas City, MO, CCN 261108 Federally qualified health center Operational/Managerial Control Apr 14, 1971
KC Care Health CenterKansas City, MO, CCN 261117 Federally qualified health center Operational/Managerial Control Apr 14, 1971

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 3

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": "1489363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606262400000",
    "number": "1770024663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3515 BROADWAY BLVD",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641112501",
            "telephone_number": "816-753-5144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4601 INDEPENDENCE AVE",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "64124",
            "telephone_number": "816-753-5144",
            "fax_number": "816-753-0804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KANSAS CITY CARE CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KANSAS CITY CARE CLINIC",
        "enumeration_date": "2017-03-13",
        "last_updated": "2020-11-25",
        "certification_date": "2020-11-25",
        "status": "A",
        "authorized_official_last_name": "FRANKLIN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "WILSON",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "816-777-2763",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500005358",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KC CARE Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kansas City, MO

Sources for this page

Verify at the official NPI Registry.