| Samuel U. Rodgers Health Center, Inc. | |
|
825 Euclid Avenue Kansas City MO 64124 | |
| (816) 474-4920 | |
| (816) 889-1845 |
| Full Name | Samuel U. Rodgers Health Center, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 825 Euclid Avenue, Kansas City, Missouri |
| Authorized Official Name and Position | Robert Theis (ACTING CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 8164744920 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Samuel U. Rodgers Health Center, Inc. 825 Euclid Avenue Kansas City MO 64124-2323 Ph: (816) 474-4920 | Samuel U. Rodgers Health Center, Inc. 825 Euclid Avenue Kansas City MO 64124 Ph: (816) 474-4920 |
| NPI Number | 1578570982 |
|---|---|
| Provider Enumeration Date | 08/01/2006 |
| Last Update Date | 06/11/2019 |
| Medicare PECOS PAC ID | 9739092826 |
|---|---|
| Medicare Enrollment ID | O20031105000813 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578570982 | NPI | - | NPPES |
| 500859111 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | H80CS00784 (Missouri) | Primary |
| Provider Name | William Carroll Lahue |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1962469494 PECOS PAC ID: 6608772066 Enrollment ID: I20031208001041 |
| Provider Name | Sangeeta Jignesh Dalal |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1487612594 PECOS PAC ID: 6103830336 Enrollment ID: I20060126000853 |
| Provider Name | Donna J Gowin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1407910318 PECOS PAC ID: 5890705123 Enrollment ID: I20060501000428 |
| Provider Name | Beverly Dark Graves |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1538136858 PECOS PAC ID: 7416954276 Enrollment ID: I20061109000066 |
| Provider Name | Cindy G Ruttan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1699718254 PECOS PAC ID: 4183726821 Enrollment ID: I20070226000774 |
| Provider Name | Shannon L Johnston |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831103225 PECOS PAC ID: 8921102948 Enrollment ID: I20070402000244 |
| Provider Name | Jason Dee Butler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417073297 PECOS PAC ID: 7113023128 Enrollment ID: I20070509000021 |
| Provider Name | Ginger A Vaughn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780879312 PECOS PAC ID: 9234228347 Enrollment ID: I20071127000613 |
| Provider Name | Deborah Ann Jantsch |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1215914734 PECOS PAC ID: 4789752098 Enrollment ID: I20091001000388 |
| Provider Name | Carol E Kirila |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1528013554 PECOS PAC ID: 2163558149 Enrollment ID: I20100329001044 |
| Provider Name | Alvin Smith |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1336177534 PECOS PAC ID: 0749490464 Enrollment ID: I20110211000459 |
| Provider Name | Mahdokht A Farahani |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1942515069 PECOS PAC ID: 4385802545 Enrollment ID: I20120220001140 |
| Provider Name | Gregory Nurrenbern |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124390620 PECOS PAC ID: 1850550526 Enrollment ID: I20120315000643 |
| Provider Name | Robert N Cooley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376603084 PECOS PAC ID: 8921012089 Enrollment ID: I20130618000110 |
| Provider Name | Griselda R Williams |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306281993 PECOS PAC ID: 2062646987 Enrollment ID: I20131009000551 |
| Provider Name | Anastasia Meixner Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528480506 PECOS PAC ID: 4789815366 Enrollment ID: I20140324002215 |
| Provider Name | Daniel Gillen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447671060 PECOS PAC ID: 4587896840 Enrollment ID: I20140421000715 |
| Provider Name | Muhammad Imran |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1881987071 PECOS PAC ID: 6507085875 Enrollment ID: I20140918001227 |
| Provider Name | Archana G Kulkarni |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1922292630 PECOS PAC ID: 0941421077 Enrollment ID: I20141015000195 |
| Provider Name | Sydney A Sigler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043602089 PECOS PAC ID: 1557689064 Enrollment ID: I20150414000445 |
| Provider Name | Orlando Lionel Silva |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1760462691 PECOS PAC ID: 3577877034 Enrollment ID: I20150729007186 |
| Provider Name | Michelle Perez |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1073779633 PECOS PAC ID: 9335453711 Enrollment ID: I20150729008046 |
| Provider Name | Amanda Joanne Whiting |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1093036097 PECOS PAC ID: 4183932361 Enrollment ID: I20151008000744 |
| Provider Name | Kyong Kong |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1831104579 PECOS PAC ID: 4183933922 Enrollment ID: I20151019001943 |
| Provider Name | Taghogho Agarin |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1386993814 PECOS PAC ID: 4789819798 Enrollment ID: I20151202001201 |
| Provider Name | Chelsea L Phelps |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144603119 PECOS PAC ID: 6507160769 Enrollment ID: I20160209000250 |
| Provider Name | Tracy Lynn Gray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982009312 PECOS PAC ID: 8729305123 Enrollment ID: I20160728002400 |
| Provider Name | Cody Robert Unnruh Ryan |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1417390956 PECOS PAC ID: 7416250592 Enrollment ID: I20160817001310 |
| Provider Name | Amy K Walker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689121477 PECOS PAC ID: 0749578995 Enrollment ID: I20161011000293 |
| Provider Name | Marisa Lorraine Maher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912454364 PECOS PAC ID: 0143505271 Enrollment ID: I20170331001813 |
| Provider Name | Katie Nicole Brinton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740717602 PECOS PAC ID: 8628345535 Enrollment ID: I20170525000260 |
| Provider Name | Edith Colette Wimsatt |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1437405503 PECOS PAC ID: 1052681475 Enrollment ID: I20170718002528 |
| Provider Name | Miranda Alise Jimenez |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1861912578 PECOS PAC ID: 8820369473 Enrollment ID: I20170801001358 |
| Provider Name | Keri Williams |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164931184 PECOS PAC ID: 7911272059 Enrollment ID: I20170929000429 |
| Provider Name | Carolina Elizabeth Uribe |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508366626 PECOS PAC ID: 3375804735 Enrollment ID: I20180227001235 |
| Provider Name | Catricia Renea Tilford |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1912135450 PECOS PAC ID: 9133368301 Enrollment ID: I20180412001264 |
| Provider Name | Brianna Hoisington |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417457565 PECOS PAC ID: 4183989429 Enrollment ID: I20180607001650 |
| Provider Name | Toni Shante Zink |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497927305 PECOS PAC ID: 0345412847 Enrollment ID: I20180612000901 |
| Provider Name | Pamela Marie Bevan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164635637 PECOS PAC ID: 0749355600 Enrollment ID: I20180809005074 |
| Provider Name | Stacey Hunt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558929471 PECOS PAC ID: 5890029722 Enrollment ID: I20190627000326 |
| Provider Name | Robbie S Harriford |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1801278627 PECOS PAC ID: 7618260993 Enrollment ID: I20190722001069 |
| Provider Name | Richard S Campos |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1710530464 PECOS PAC ID: 4587992029 Enrollment ID: I20190822000914 |
| Provider Name | Leann Kridelbaugh |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1174627699 PECOS PAC ID: 9537434428 Enrollment ID: I20190822000968 |
| Provider Name | Paola Maria Capra |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942856760 PECOS PAC ID: 9335479856 Enrollment ID: I20190926001376 |
| Provider Name | Niva Shakya |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1073829933 PECOS PAC ID: 0143469411 Enrollment ID: I20191001001703 |
| Provider Name | Heather Renee Colaizzi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841840659 PECOS PAC ID: 1951633403 Enrollment ID: I20191101001413 |
| Provider Name | Elizabeth L Blanchard Hills |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013483031 PECOS PAC ID: 0941431282 Enrollment ID: I20200131002118 |
| Provider Name | Allison Layne Manz |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1326426172 PECOS PAC ID: 0840601233 Enrollment ID: I20201116000381 |
| Provider Name | Avonne Danell Rosario |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053957472 PECOS PAC ID: 2567873243 Enrollment ID: I20201202000099 |
| Provider Name | Jourdan Nikole Heitschmidt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598391484 PECOS PAC ID: 8820411754 Enrollment ID: I20210615002942 |
| Provider Name | Ramin Aris |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1275100653 PECOS PAC ID: 0345644480 Enrollment ID: I20210811001369 |
| Provider Name | Kathleen Anne Titterington Tritsch |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1154559235 PECOS PAC ID: 3779987813 Enrollment ID: I20210811001506 |
| Provider Name | Frederick Peterson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1790708725 PECOS PAC ID: 0345269361 Enrollment ID: I20210824003212 |
| Provider Name | Tiffany Swanson |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1437697356 PECOS PAC ID: 5597035493 Enrollment ID: I20210914000457 |
| Provider Name | Mckenzie Elizabeth Crouse |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154994630 PECOS PAC ID: 4183021066 Enrollment ID: I20210920001391 |
| Provider Name | Lydia Nganga |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023784907 PECOS PAC ID: 2264820810 Enrollment ID: I20211101001083 |
| Provider Name | Bethany H Vandevender |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1871727826 PECOS PAC ID: 7618365263 Enrollment ID: I20211101001098 |
| Provider Name | Jeffrey Utter |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093248056 PECOS PAC ID: 1456620582 Enrollment ID: I20211101001230 |
| Provider Name | Melanie Farris |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831454461 PECOS PAC ID: 7517275944 Enrollment ID: I20211101001697 |
| Provider Name | Suzana Gjino |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1396300547 PECOS PAC ID: 1850779604 Enrollment ID: I20220607000926 |
| Provider Name | Jacquelyn Bailey |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699238204 PECOS PAC ID: 3476888223 Enrollment ID: I20220930000580 |
| Provider Name | Benjamin Sanley |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1831395094 PECOS PAC ID: 0648568840 Enrollment ID: I20221206000909 |
| Provider Name | Katherine C Jorgenson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1841816253 PECOS PAC ID: 9234508193 Enrollment ID: I20221215001690 |
| Provider Name | Rebekah Ann O'donnell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144937616 PECOS PAC ID: 8628448438 Enrollment ID: I20230111002135 |
| Provider Name | Damalye Barclay-debi |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1992428189 PECOS PAC ID: 5294107074 Enrollment ID: I20230203000550 |
| Provider Name | Tara Marie Gabriel |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1588643381 PECOS PAC ID: 5496113847 Enrollment ID: I20230616002938 |
| Provider Name | Brandon T Ortega |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1851075428 PECOS PAC ID: 2668831967 Enrollment ID: I20230705001761 |
| Provider Name | Anna Olivia Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982488292 PECOS PAC ID: 9537514393 Enrollment ID: I20231013001550 |
| Provider Name | Alesha Mahone |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659151900 PECOS PAC ID: 9234584095 Enrollment ID: I20231013001740 |
| Provider Name | Aisha Paki Usman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831973056 PECOS PAC ID: 9133575574 Enrollment ID: I20231021000230 |
| Provider Name | Tanairi Kennedy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285408674 PECOS PAC ID: 7517315880 Enrollment ID: I20231127002425 |
| Provider Name | Michelle Darby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952166530 PECOS PAC ID: 8123463585 Enrollment ID: I20240226002632 |
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