| Contacts | Primary Contact | Update | Group Change Request | Little, Jeff
Director of Pharmacy
Saint Luke's Hospital
8169322408 | Flanagin, Connor Matthew
Director of Pharmacy
Saint Luke's Hospital of Kansas City
8169322431 | 4/14/2025 2:03 PM |
| Contacts | Authorizing Official | Update | Profile Change Request | Nachtigal, Amy
CFO
Saint Luke's Hospital of Kansas City
8169323318 | Nachtigal, Amy
VP Finance
Saint Luke's Hospital of Kansas City
8169323318 | 4/14/2025 1:59 PM |
| Contacts | Signed By | Update | Profile Change Request | Nachtigal, Amy
CFO
Saint Luke's Hospital of Kansas City
8169323318 | Nachtigal, Amy
VP Finance
Saint Luke's Hospital of Kansas City
8169323318 | 4/14/2025 1:59 PM |
| Details | Last Recertification Date | Update | Recertification | 8/17/2023 2:36:42 PM | 8/22/2024 7:07:16 PM | 8/22/2024 7:07 PM |
| Addresses | Shipping Address | Delete | Group Change Request | St. Luke's Hospital of Kansas City
Wornall Road at Forty Fourth
Kansas City, MO 64111 | | 10/25/2023 8:05 AM |
| Addresses | Shipping Address | Insert | Group Change Request | | Saint Luke's Hospital of Kansas City
4401 Wornall Road
Kansas City, MO 64111 | 10/25/2023 8:05 AM |
| Addresses | Billing Address | Update | Recertification | Saint Luke's Hospital
PO Box 5870
Kansas City, MO 64717-0870 | Saint Luke's Hospital
PO Box 5870
Kansas City, MO 64171-0870 | 8/17/2023 2:36 PM |
| Details | Last Recertification Date | Update | Recertification | 9/1/2022 12:56:30 PM | 8/17/2023 2:36:42 PM | 8/17/2023 2:36 PM |
| Details | Last Recertification Date | Update | Recertification | 9/8/2021 3:48:40 PM | 9/1/2022 12:56:30 PM | 9/1/2022 12:56 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Group Change Request | | False | 12/16/2021 8:55 AM |
| Medicaid Billing | Medicaid: Number | Insert | Group Change Request | | 600012785 | 12/16/2021 8:55 AM |
| Medicaid Billing | Medicaid: State | Insert | Group Change Request | | MO | 12/16/2021 8:55 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 12/14/2021 11:35 PM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 10326106 | 12/14/2021 11:35 PM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | MO | 12/14/2021 11:35 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1063494177 | 12/14/2021 11:35 PM |
| Medicaid Billing | NPI: State | Insert | Change Request | | MO | 12/14/2021 11:35 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1134566409 | 12/14/2021 11:35 PM |
| Medicaid Billing | NPI: State | Insert | Change Request | | MO | 12/14/2021 11:35 PM |
| Addresses | Billing Address | Insert | Recertification | | Saint Luke's Hospital
PO Box 5870
Kansas City, MO 64717-0870 | 9/8/2021 3:48 PM |
| Details | Last Recertification Date | Update | Recertification | 8/31/2020 10:29:34 AM | 9/8/2021 3:48:40 PM | 9/8/2021 3:48 PM |
| Medicaid Billing | Medicaid: Number | Delete | Change Request | 010326106 (MO) | | 6/15/2021 12:39 PM |
| Medicaid Billing | NPI: Number | Delete | Change Request | 1063494177 (MO) | | 6/15/2021 12:39 PM |
| Addresses | Shipping Address | Insert | Recertification | | St. Luke's Hospital of Kansas City
Wornall Road at Forty Fourth
Kansas City, MO 64111 | 8/31/2020 10:29 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1063494177 | 8/31/2020 10:29 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | MO | 8/31/2020 10:29 AM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1063494177 ( ) | | 8/31/2020 10:29 AM |
| Details | Last Recertification Date | Update | Recertification | 8/20/2019 2:39:39 PM | 8/31/2020 10:29:34 AM | 8/31/2020 10:29 AM |
| Details | Last Recertification Date | Update | Recertification | 8/29/2018 10:39:56 AM | 8/20/2019 2:39:39 PM | 8/20/2019 2:39 PM |
| Details | Last Recertification Date | Update | Recertification | 11/29/2017 5:34:02 PM | 8/29/2018 10:39:56 AM | 8/29/2018 10:39 AM |
| Details | Entity Name | Update | Recertification | ST. LUKES HOSPITAL OF KANSAS CITY | ST. LUKE'S HOSPITAL OF KANSAS CITY | 11/29/2017 7:44 PM |
| Details | Last Recertification Date | Update | Recertification | 8/16/2016 12:00:00 AM | 11/29/2017 5:34:02 PM | 11/29/2017 5:34 PM |
| Contacts | Authorizing Official | Update | | Nachtigal, Amy
CFO
8169323318 | Nachtigal, Amy
CFO
Saint Luke's Hospital of Kansas City
8169323318 | 10/25/2017 2:23 PM |
| Contacts | Signed By | Update | | Nachtigal, Amy
CFO
8169323318 | Nachtigal, Amy
CFO
Saint Luke's Hospital of Kansas City
8169323318 | 10/25/2017 2:23 PM |
| Contacts | Primary Contact | Update | | Little, Jeff
Director of Pharmacy
8169322408 | Little, Jeff
Director of Pharmacy
Saint Luke's Hospital
8169322408 | 10/9/2017 2:19 PM |
| Addresses | Main Address | Insert | | |
4320 Wornall Road
Suite 65
Kansas City, MO 64111 | 7/24/2017 6:51 PM |
| Contacts | Authorizing Official | Insert | | | Nachtigal, Amy
CFO
8169323318 | 7/24/2017 6:51 PM |
| Contacts | Signed By | Insert | | | Nachtigal, Amy
CFO
8169323318 | 7/24/2017 6:51 PM |
| Contacts | Primary Contact | Insert | | | Little, Jeff
Director of Pharmacy
8169322408 | 7/24/2017 6:51 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1063494177 | 4/14/2017 12:04 PM |
| Details | Last Recertification Date | Update | | | 8/16/2016 12:00:00 AM | 8/16/2016 10:31 AM |
| Dates | Participating Approval Date | Update | | | 5/13/2016 12:00:00 AM | 5/13/2016 12:51 PM |
| Details | State | Update | | Pending | Active | 5/13/2016 12:51 PM |
| Dates | Start Date | Update | | | 7/1/2016 12:00:00 AM | 5/13/2016 12:51 PM |
| Details | 340B ID | Update | | OUTPATIENT_ONLINE_REG_60077 | DSH260138L | 5/10/2016 12:01 PM |
| Details | Entity Subname | Update | | SLH Multispecialty Clinic | Multispecialty Clinic | 5/10/2016 12:01 PM |
| Details | 340B ID | Update | | | OUTPATIENT_ONLINE_REG_60077 | 4/13/2016 2:38 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 4/13/2016 2:38 PM |
| Medicaid Billing | Medicaid: Number | Insert | | | 010326106 | 4/13/2016 2:38 PM |
| Medicaid Billing | Medicaid: State | Insert | | | MO | 4/13/2016 2:38 PM |
| Details | Last Recertification Date | Insert | | | | 4/13/2016 2:38 PM |
| Details | Grant Number | Insert | | | | 4/13/2016 2:38 PM |
| Details | 340B ID | Insert | | | | 4/13/2016 2:38 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 4/13/2016 2:38 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 4/13/2016 2:38 PM |
| Details | Medicare Provider Number | Insert | | | 260138 | 4/13/2016 2:38 PM |
| Details | Entity Name | Insert | | | ST. LUKES HOSPITAL OF KANSAS CITY | 4/13/2016 2:38 PM |
| Details | Program Code | Insert | | | DSH | 4/13/2016 2:38 PM |
| Details | Entity Subname | Insert | | | SLH Multispecialty Clinic | 4/13/2016 2:38 PM |
| Dates | Participating Approval Date | Insert | | | | 4/13/2016 2:38 PM |
| Details | State | Insert | | | Pending | 4/13/2016 2:38 PM |
| Dates | Registration Date | Insert | | | 4/13/2016 12:00:00 AM | 4/13/2016 2:38 PM |
| Dates | Signed By Date | Insert | | | 4/13/2016 12:00:00 AM | 4/13/2016 2:38 PM |
| Dates | Start Date | Insert | | | | 4/13/2016 2:38 PM |
| Terminations | Termination Comments | Insert | | | | 4/13/2016 2:38 PM |
| Terminations | Termination Date | Insert | | | | 4/13/2016 2:38 PM |
| Terminations | Termination Effective Date | Insert | | | | 4/13/2016 2:38 PM |
| Terminations | Termination Reason | Insert | | | | 4/13/2016 2:38 PM |