NPIMap

Organization Active NPI

Affinia Healthcare

  • Federally Qualified Health Center (FQHC)
  • Saint Louis, MO
National Provider Identifier
1902816077
Registry record updated Apr 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
507226801 Issued in MO
Legal business name
AFFINIA HEALTHCARE
Practice address
1717 Biddle St
Saint Louis, MO 63106-3454
Phone
(314) 898-1700
NPI assigned
Aug 9, 2006
Last updated
Apr 7, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2016

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

Authorized official

Name
Mrs. Janet Voss
Title
Cfo
Phone
(314) 814-8571

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 507226801 MO Primary

Addresses

Primary practice location

1717 Biddle St
Saint Louis, MO 63106-3454

Mailing address

PO Box 551
Saint Louis, MO 63188-0551
Phone (314) 814-8515

Other identifiers 2

IdentifierTypeStateIssuer
507226801MedicaidMO
26D1046060OtherMOCLIA

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040902000048 MO Part B Supplier - Clinic/Group Practice 1052386919 Receives reassigned benefits from 90 practitioners
5 other NPIs on this enrollment
Practice locations: Saint Louis, MO
O20051019000460 MO Part A Provider - Federally Qualified Health Center (FQHC) 1052386919 Practice locations: Saint Louis, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902816077. Details of each certification follow.

Federally qualified health center certification: CCN 261888

Legal name
AFFINIA HEALTHCARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 25, 2005
Last certification
Oct 25, 2005
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jul 13, 1964 in MO
Enrollment address
1717 Biddle St
Saint Louis, MO 63106-3454

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Tax ID family
Affinia Healthcare21 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

1717 Biddle St
Saint Louis, MO 63106
Phone (314) 814-8515

Ownership & related parties

All disclosed owners & managing parties 20

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

NameRoleSinceShare
Araceli Escalante-Gudino Individual Corporate Officer Jan 1, 2021
Riisa Rawlins Individual Corporate Officer Jan 1, 2022
Mary Dambrose Individual Corporate DirectorBoard Member Oct 19, 2005
Kevin Hachegechog Individual Corporate Officer Jan 1, 2022
Vickie J Lomax Individual Corporate DirectorBoard of Director Member Oct 19, 2005
Robert Jacobson Individual Corporate OfficerExecutive Committee Member of TH Oct 19, 2005
Debra Johns Individual Corporate DirectorBoard Member Oct 9, 2005
Kimball McMullin Individual Corporate Director Jan 25, 2016
Georgia Harris Individual Corporate Officer Jan 1, 2022
David Walters Individual Corporate Officer Jan 1, 2021
Jean M Frazee Individual Corporate OfficerTreasurer Oct 19, 2005
Laurel Tinsley Individual Corporate Officer Jan 1, 2021
Tondaleria Curry Individual Corporate DirectorBoard Member Jan 1, 2008
Janet L Voss Individual Corporate OfficerVP/Cfo Oct 19, 2005 100%
Operational/Managerial ControlVP/Cfo Oct 19, 2005 100%
Mitchell L Baris Individual Corporate OfficerChairman of Board of Director Oct 19, 2005
Carrollton Bank Organization, Clayton, MO Created for acquisition, Financial institution 5% Or Greater Mortgage Interest Mar 17, 2017 30.6%
Gwendolyn Hall Individual Corporate DirectorBoard Member Jan 1, 2009
Alan O Freeman Individual Corporate DirectorCeo/President Nov 13, 2006 100%
W-2 Managing EmployeeCeo/President Nov 13, 2006 100%
Paula R Davis Individual Corporate Director Jan 25, 2016
Gilbert Peoples Individual Corporate OfficerSecretary Jan 1, 2009

Practitioners & affiliated clinicians

Practitioners 92

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.

View all 92

NPI Registry JSON

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459987200000",
    "number": "1902816077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 551",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631880551",
            "telephone_number": "314-814-8515",
            "fax_number": "314-814-8542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 BIDDLE ST",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631063454",
            "telephone_number": "314-898-1700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AFFINIA HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-09",
        "last_updated": "2016-04-07",
        "status": "A",
        "authorized_official_last_name": "VOSS",
        "authorized_official_first_name": "JANET",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "314-814-8571",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MO",
            "license": "507226801",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "507226801",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "26D1046060",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.