NPIMap

Organization Active NPI

Swope Health Services

Doing business as Swope Health - Excelsior Springs Pediatric Clinic

  • Federally Qualified Health Center (FQHC)
  • Excelsior Springs, MO
National Provider Identifier
1932881380
Registry record updated Oct 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SWOPE HEALTH SERVICES
Doing business as
Swope Health - Excelsior Springs Pediatric Clinic
Practice address
500 N Jesse James Rd
Excelsior Springs, MO 64024-3614
Phone
(816) 923-5800
NPI assigned
Aug 4, 2023
Last updated
Oct 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2024

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

Authorized official

Name
Essence Montgomery
Title
Cfo
Phone
(816) 599-5683

Specialties & licenses 1

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

Addresses

Primary practice location

500 N Jesse James Rd
Excelsior Springs, MO 64024-3614

Mailing address

3801 Dr Martin Luther King Jr Blvd
Kansas City, MO 64130-2807
Phone (816) 599-5661

Other names 1

  • Swope Health - Excelsior Springs Pediatric Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040416000940 MO Part B Supplier - Clinic/Group Practice 5294644530 Receives reassigned benefits from 176 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kansas City, MO; Riverside, MO; Independence, MO; Excelsior Springs, MO; Belton, MO
O20240521001088 MO Part A Provider - Federally Qualified Health Center (FQHC) 5294644530 Practice locations: Excelsior Springs, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1932881380. Details of each certification follow.

Federally qualified health center certification: CCN 791056

Legal name
SWOPE HEALTH SERVICES
Doing business as
SWOPE HEALTH - EXCELSIOR SPRINGS PEDIATRIC CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 8, 2024
Last certification
Aug 8, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
500 N Jesse James Rd
Excelsior Springs, MO 64024-3614

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 11

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D2290077Swope Health-Excelsior Springs Pediatric Clinic500 N Jesse James Road, Excelsior Springs, MO 64024Certificate of waiverSep 19, 2027

National Provider Directory

National Provider Directory
Tax ID family
Swope Parkway HLTH Ctr32 organizations share this tax ID, including this one

Other organizations with this tax ID 31

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

View all 31

Locations

500 N Jesse James Rd
Excelsior Springs, MO 64024
Phone (816) 321-3240

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
Yolanda Sims Individual Corporate DirectorBoard Member Mar 11, 2014
W-2 Managing Employee Mar 11, 2014
Harry E Wilkins Individual Corporate DirectorBoard Member Mar 9, 2010
W-2 Managing Employee Mar 9, 2010
Elizabeth Preston Individual Corporate DirectorBoard Member Mar 8, 2016
W-2 Managing Employee Mar 8, 2016
Tom H Kokjer Individual Corporate DirectorBoard Member Dec 12, 2017
W-2 Managing Employee Dec 12, 2017
Jack III Cannon Individual Corporate DirectorBoard Member Apr 11, 2017
W-2 Managing Employee Apr 11, 2017
Tresia Franklin Individual Corporate DirectorBoard Member Mar 10, 2015
W-2 Managing Employee Mar 10, 2015
Jack McCanna Individual Corporate DirectorBoard Member Mar 8, 2016
W-2 Managing Employee Mar 8, 2016
Juan M Rangel Individual Corporate DirectorBoard Member Jan 9, 2018
W-2 Managing Employee Jan 9, 2018
Essence Montgomery Individual Corporate OfficerCfo Aug 7, 2024
W-2 Managing EmployeeCfo Aug 7, 2024
Operational/Managerial ControlCfo Aug 7, 2024
Jeron Ravin Individual Corporate OfficerCeo & President Aug 26, 2019 100%
W-2 Managing EmployeeCeo & President Aug 26, 2019
Linda Adkison Individual Corporate DirectorBoard Member Mar 11, 2014
W-2 Managing Employee Mar 11, 2014

All facility ownership & control disclosures 6

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

FacilityTypeRoleSince
Swope Health ServicesKansas City, MO, CCN 261802 Federally qualified health center Operational/Managerial Control (100%) Nov 24, 1969
Swope Health ServicesBelton, MO, CCN 261077 Federally qualified health center Operational/Managerial Control (100%) Mar 3, 2014
Swope Health ServicesKansas City, MO, CCN 261115 Federally qualified health center Operational/Managerial Control (100%) Dec 9, 2015
Swope Health ServicesKansas City, MO, CCN 261139 Federally qualified health center Operational/Managerial Control (100%) Feb 23, 2017
Swope Health ServicesKansas City, MO, CCN 791166 Federally qualified health center Operational/Managerial Control (100%) Feb 22, 2021
Swope Health ServicesKansas City, MO, CCN 261903 Federally qualified health center Operational/Managerial Control (100%) Feb 5, 2022

Owned or controlled facilities with NPI records 6

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

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1691107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730160000000",
    "number": "1932881380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3801 DR MARTIN LUTHER KING JR BLVD",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641302807",
            "telephone_number": "816-599-5661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 N JESSE JAMES RD",
            "city": "EXCELSIOR SPRINGS",
            "state": "MO",
            "postal_code": "640243614",
            "telephone_number": "816-923-5800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SWOPE HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-04",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A",
        "authorized_official_last_name": "MONTGOMERY",
        "authorized_official_first_name": "ESSENCE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "816-599-5683"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Swope Health - Excelsior Springs Pediatric Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Excelsior Springs, MO

Sources for this page

Verify at the official NPI Registry.