ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS (NPI# 1255391611) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255391611 |
| Entity Type | Organization |
| Organization Name | ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS |
| Other Organization Name | SSM HEALTH ST. MARY'S HOSPITAL - CENTRALIA |
| Practice Address |
400 N Pleasant Ave Centralia IL 62801 |
| Mailing Address |
1195 Corporate Lake Dr Saint Louis MO 63132-1716 |
| Practice Telephone | 6184368000 |
| Mailing Telephone | 3149893524 |
| Mailing Fax Number | 3149893695 |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2019-11-26 |
| Authorized Official Name | MR. DAMON R HARBISON (PRESIDENT) |
| Authorized Official Telephone | 6184368000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 273R00000X | Psychiatric Unit | 0002642 | IL | Hospital Units |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | HEALTH ALLIANCE | 154401 | 01 |
| Other Name | Type Code |
|---|---|
| SSM Health St. Mary's Hospital - Centralia | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477097871 | St. Mary's Hospital, Centralia, Illinois | Anesthesiology | 400 N Pleasant Ave, Centralia, IL 62801-3056 | 2016-12-05 |
| 1710105192 | St. Mary's Hospital, Centralia, Illinois | Clinic/Center | 400 N Pleasant Ave, Centralia, IL 62801 | 2007-04-23 |
| 1770687196 | St. Mary's Hospital, Centralia, Illinois | Internal Medicine | 400 N Pleasant Ave, Centralia, IL 62801-3056 | 2006-09-08 |
| 1629003074 | St. Mary's Hospital, Centralia, Illinois | Clinic/Center | 400 N Pleasant Ave, Centralia, IL 62801 | 2006-07-12 |
| Street Address |
400 N PLEASANT AVE |
| City | CENTRALIA |
| State | IL |
| Zip Code | 62801 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083617245 | St Mary's Hospital, Centralia, Illinois | Psychiatric Unit | 400 N Pleasant Ave, Centralia, IL 62801 | 2005-05-23 |
| 1538649967 | Dana Leigh Trame | Nurse Practitioner | 400 N Pleasant Ave, Centralia, IL 62801-3056 | 2018-08-15 |
| 1487132387 | Brandy Harrison | Nurse Practitioner | 400 N Pleasant Ave, Centralia, IL 62801-3056 | 2018-08-02 |
| 1225539398 | Virginia Yvonne Wagner | Social Worker | 400 N Pleasant Ave, Centralia, IL 62801-3056 | 2018-02-23 |
| 1588105654 | Jana Tull | Nurse Practitioner | 400 N Pleasant Ave, Centralia, IL 62801-3056 | 2017-03-09 |
| 1477097871 | St. Mary's Hospital, Centralia, Illinois | Anesthesiology | 400 N Pleasant Ave, Centralia, IL 62801-3056 | 2016-12-05 |
| 1770031841 | Barbara Dawn Becker | Nurse Practitioner | 400 N Pleasant Ave, Centralia, IL 62801-3056 | 2016-09-16 |
| 1831534460 | Gopinath Gorthy | Psychiatry & Neurology | 400 N Pleasant Ave, Centralia, IL 62801-3056 | 2013-05-09 |
| 1982930079 | Linda D Bryan | Speech-Language Pathologist | 400 N Pleasant Ave, Centralia, IL 62801-3056 | 2009-10-23 |
| 1710105192 | St. Mary's Hospital, Centralia, Illinois | Clinic/Center | 400 N Pleasant Ave, Centralia, IL 62801 | 2007-04-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356996151 | Matthew Crawford | Counselor | 904 E Martin Luther King Dr, Centralia, IL 62801 | 2019-08-08 |
| 1588130314 | Kennah White | Counselor | 904 E. Mlk Drive, Centralia, IL 62801 | 2018-10-19 |
| 1245721588 | Lindsey Nicole Fogliasso | Counselor | 904 East Mlk Dr., Centralia, IL 62801 | 2018-05-22 |
| 1629573365 | Prabhat Shrestha | Student in an Organized Health Care Education/Training Program | 605 Sable Drive, Centralia, IL 62801 | 2018-03-26 |
| 1619496098 | Whitney Rathmann | Speech-Language Pathologist | 224 South Locust, Centralia, IL 62801 | 2017-09-17 |
| 1376082685 | Athena A Smith | Counselor | 904 E. Martin Luther King Dr, Centralia, IL 62801 | 2017-02-20 |
| 1447704069 | Meghan Branch | Counselor | 904 Martin Luther King Dr, Centralia, IL 62801 | 2016-08-11 |
| 1568820637 | Midland Area Agency On Aging | Case Management | 434 S Poplar Street, Centralia, IL 62801 | 2016-02-04 |
| 1104201714 | Keri Douglas | Nurse Practitioner | 1054 M. L. King Drive #125, Centrailia, IL 62801 | 2015-07-24 |
| 1215331509 | Melissa Dane | Counselor | 904 E Martin Luther King Dr., Centralia, IL 62801 | 2014-10-15 |
| Find all providers in zip 62801 | ||||
| Taxonomy Code | 273R00000X |
| Grouping | Hospital Units |
| Classification | Psychiatric Unit |
| In general, a distinct unit of a hospital that provides acute or long-term care to emotionally disturbed patients, including patients admitted for diagnosis and those admitted for treatment of psychiatric problems on the basis of physicians' orders and approved nursing care plans. Long-term care may include intensive supervision to the chronically mentally ill, mentally disordered or other mentally incompetent persons; (2) For Medicare, a distinct part of a general acute care hospital admitting only patients whose admission to the unit is required for active treatment, whose treatment is of an intensity that can be provided only in an inpatient hospital setting, and whose condition is described by a psychiatric principal diagnosis contained in the Third Edition of the American Psychiatric Association Diagnostic and Statistical Manual or in Chapter 5 (Mental Disorders) of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). The unit must furnish, through the use of qualified personnel, psychological services, social work services, psychiatric nursing, occupational therapy, and recreational therapy. The unit must maintain medical records that permit determination of the degree and intensity of treatment provided to individuals who are furnished services in the unit; the unit must meet special staff requirements in that the unit must have adequate numbers of qualified professional and supportive staff to evaluate inpatients, formulate written, individualized, comprehensive treatment plans, provide active treatment measures and engage in discharge planning. |
| Notes: Source: (1) AHA Annual Survey p. A10 1996 AHA Guide; (2) Code of Federal Regulations #42, Section 412.27. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083617245 | St Mary's Hospital, Centralia, Illinois | Psychiatric Unit | 400 N Pleasant Ave, Centralia, IL 62801 | 2005-05-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639657414 | Advocate North Side Health Network | Psychiatric Unit | 836 W Wellington Ave., Chicago, IL 60657 | 2018-08-02 |
| 1427547538 | Holy Cross Hospital | Psychiatric Unit | 2701 West 68th Street, Chicago, IL 60629 | 2018-05-03 |
| 1740570316 | Robert Young Center | Psychiatric Unit | 4200 6th Ave, Rock Island, IL 61201-2109 | 2011-04-15 |
| 1669704326 | Isaac Ray Center At Cermak | Psychiatric Unit | 3159 N Seminary #301, Chicago, IL 60657 | 2010-02-05 |
| 1316115223 | 394567 D North | Psychiatric Unit | 4200 North Oak Park Ave, Chicago, IL 60634-1417 | 2008-02-13 |
| 1508034414 | 395061 Med Eval | Psychiatric Unit | 4200 North Oak Park Avenue, Chicago, IL 60634-1417 | 2008-02-13 |
| 1952425076 | Elgin Mental Health Center William White 4585 | Psychiatric Unit | 750 S. State St., Elgin, IL 60123-7692 | 2007-03-16 |
| 1932251766 | Families and Adolescents In Recovery, Inc. | Psychiatric Unit | 2010 E Algonquin Rd, Suite # 203-207, Schaumburg, IL 60173-4185 | 2007-01-18 |
| 1003976713 | Presence Central and Suburban Hospitals Network | Psychiatric Unit | 333 N. Madison St., Joliet, IL 60435-6595 | 2006-12-11 |
| 1871678334 | Kindred Thc Chicago, LLC | Psychiatric Unit | 2544 W Montrose Ave, Chicago, IL 60618 | 2006-10-25 |
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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.