SSM DEPAUL MEDICAL GROUP, INC. (NPI# 1073880480) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073880480 |
| Entity Type | Organization |
| Organization Name | SSM DEPAUL MEDICAL GROUP, INC. |
| Other Organization Name | SSM HEALTH MEDICAL GROUP |
| Practice Address |
2305 Georgia St Louisiana MO 63353-2559 |
| Mailing Address |
1551 Wall St Suite 310 Saint Charles MO 63303-3539 |
| Practice Telephone | 3142910846 |
| Practice Fax Number | 5737546056 |
| Mailing Telephone | 6366692268 |
| Mailing Fax Number | 3142098127 |
| Enumeration Date | 2011-11-30 |
| Last Update Date | 2016-01-15 |
| Authorized Official Name | LAURA PULLUM (BILLING MANAGER) |
| Authorized Official Telephone | 6366692434 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| SSM Health Medical Group | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639180631 | Ssm Depaul Medical Group, Inc. | Family Medicine | 1821 Sherman Dr, Saint Charles, MO 63303-3984 | 2006-08-11 |
| 1003929407 | Ssm Depaul Medical Group, Inc. | Family Medicine | 12255 De Paul Dr, Suite 200, Bridgeton, MO 63044-2510 | 2006-08-17 |
| 1174636575 | Ssm Depaul Medical Group, Inc. | Family Medicine | 12255 De Paul Dr, Suite 600, Bridgeton, MO 63044-2510 | 2006-08-17 |
| 1154434736 | Ssm Depaul Medical Group, Inc. | Neurological Surgery | 12255 De Paul Dr, Suite 830, Bridgeton, MO 63044-2510 | 2006-08-16 |
| 1881605905 | Ssm Depaul Medical Group, Inc. | Family Medicine | 9068 Overland Plz, Overland, MO 63114-6122 | 2006-08-11 |
| 1376554345 | Ssm Depaul Medical Group, Inc. | Obstetrics & Gynecology | 12277 De Paul Dr, Suite 403, Bridgeton, MO 63044-2516 | 2006-08-11 |
| 1952312951 | Ssm Depaul Medical Group, Inc. | Pediatrics | 14021 New Halls Ferry Rd, Florissant, MO 63033-2708 | 2006-08-11 |
| 1760456743 | Ssm Depaul Medical Group, Inc. | Family Medicine | 2024 Dorsett Vlg, Maryland Heights, MO 63043-2208 | 2006-02-15 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | SSM DEPAUL MEDICAL GROUP, INC. | 10101 Woodfield Ln, Saint Louis, MO 63132-2937 |
| Street Address |
2305 GEORGIA ST |
| City | LOUISIANA |
| State | MO |
| Zip Code | 63353-2559 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023084290 | Aaron T Miller | Family Medicine | 2305 Georgia St, Louisiana, MO 63353-2559 | 2006-02-27 |
| 1932742012 | Erin Collette Anderson | Nurse Practitioner | 2305 Georgia St, Louisiana, MO 63353-2559 | 2019-10-22 |
| 1427409713 | Northeast Missouri Medical Providers LLC | Emergency Medicine | 2305 Georgia St, Louisiana, MO 63353-2559 | 2016-06-28 |
| 1538513072 | Pike County Memorial Hospital | Family Medicine | 2305 Georgia St, Louisiana, MO 63353-2559 | 2016-04-21 |
| 1225499866 | Rachel Harris | Nurse Practitioner | 2305 Georgia St, Louisiana, MO 63353-2559 | 2016-03-09 |
| 1851688774 | Martella Emergency Group LLC | Physician Assistant | 2305 Georgia St, Louisiana, MO 63353-2559 | 2011-06-29 |
| 1700108370 | Ronald C Myers | Emergency Medicine | 2305 Georgia St, Louisiana, MO 63353-2559 | 2010-02-23 |
| 1184955700 | Tarrah A Hickerson | Social Worker | 2305 Georgia St, Louisiana, MO 63353-2559 | 2010-01-21 |
| 1871738823 | Pike Emergency Medicine LLC | Emergency Medicine | 2305 Georgia St, Louisiana, MO 63353-2559 | 2008-12-04 |
| 1033300488 | Casey Amanda Jennings | Family Medicine | 2305 Georgia St, Louisiana, MO 63353-2559 | 2007-08-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063715845 | Austin Arness Brown | Physical Therapist | 2305 Georgia Street, Louisiana, MO 63353 | 2010-12-16 |
| 1962705749 | Margaret Therese Marden | Physical Therapist | 2305 West Georgia Street, Louisiana, MO 63353 | 2010-12-16 |
| 1487869582 | George Michael Vallar | Dentist | 211 Georgia St, Louisiana, MO 63353 | 2007-05-11 |
| 1558437350 | Frank T Thomalla IIi | Dentist | 3410 Georgia Street, Louisiana, MO 63353 | 2006-11-27 |
| 1346333572 | Stephen Francis Justice | Family Medicine | 2305 Georgia, Louisiana, MO 63353 | 2006-10-02 |
| 1821075672 | Mohammad Asif Waziri | Emergency Medicine | 2305 Gerorgia St, Louisiana, MO 63353 | 2005-12-22 |
| 1235432022 | Angela Theresa Gardner | Physical Therapist | 2305 Georgia Street, Louisiana, MO 63353 | 2010-12-16 |
| 1326061680 | Howard B. Schwadron, D.m.d. P.C. | Dentist | 801 Georgia St, Louisiana, MO 63353-1613 | 2006-07-26 |
| 1700800901 | Howard B. Schwadron | Dentist | 801 Georgia St, Louisiana, MO 63353-1613 | 2006-07-27 |
| 1205971132 | Family Health Pharmacies, Inc. | Durable Medical Equipment & Medical Supplies | 301 Georgia St, Louisiana, MO 63353-1717 | 2007-02-20 |
| Find all providers in zip 63353 | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689128019 | Midwest Heart Institute | Internal Medicine | 1439 Us Highway 61, Ste A, Festus, MO 63028-4153 | 2016-08-15 |
| 1477984292 | Robert A. Brinkman, M.d., LLC. | Internal Medicine | 1040 N Mason Rd Ste 211, Creve Coeur, MO 63141 | 2013-12-04 |
| 1528407822 | Justin Patrick Sheehy | Internal Medicine | 4401 Wornall Rd Fl 9, Kansas City, MO 64111-3220 | 2013-06-19 |
| 1952643520 | Meritas Health Corporation | Internal Medicine | 5501 Nw 62nd Ter Ste 201, Kansas City, MO 64151-2408 | 2013-03-21 |
| 1043557150 | Ronald Nathan Riner | Internal Medicine | 9847 Waterbury Drive, St. Louis, MO 63124 | 2013-01-09 |
| 1427315423 | Paul Larsen | Internal Medicine | 1027 Bellevue Ave Ste 200, Saint Louis, MO 63117-1851 | 2012-04-13 |
| 1275899718 | Bradley Carl Witbrodt | Internal Medicine | 3023 N Ballas Rd Ste 200, Saint Louis, MO 63131-2330 | 2012-04-10 |
| 1194004952 | Jad Raffoul | Internal Medicine | 1402 S Grand Blvd Fl 14, Saint Louis, MO 63104-1004 | 2011-08-11 |
| 1376839894 | Chetan P Huded | Internal Medicine | 5844 Nw Barry Rd Ste 230, Kansas City, MO 64154-1421 | 2011-06-22 |
| 1982999462 | Philip L Mar | Internal Medicine | 3635 Vista Ave Fl 15, Saint Louis, MO 63110-2539 | 2011-06-13 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.