GOOD SAMARITAN REGIONAL HEALTH CENTER (NPI# 1487758801) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487758801 |
| Entity Type | Organization |
| Organization Name | GOOD SAMARITAN REGIONAL HEALTH CENTER |
| Other Organization Name | SSM HEALTH GOOD SAMARITAN HOSPITAL - MT. VERNON |
| Practice Address |
1 Good Samaritan Way Mount Vernon IL 62864-2402 |
| Mailing Address |
Po Box 503927 Saint Louis MO 63150-0001 |
| Practice Telephone | 6188994600 |
| Practice Fax Number | 6185329365 |
| Mailing Telephone | 6188994600 |
| Mailing Fax Number | 6185329365 |
| Enumeration Date | 2006-09-08 |
| Last Update Date | 2019-11-22 |
| Authorized Official Name | MR. JEREMY BRADFORD (PRESIDENT) |
| Authorized Official Telephone | 6188991001 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208100000X | Physical Medicine & Rehabilitation | 0004705 | IL | Allopathic & Osteopathic Physicians |
| N | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
0004705 | IL | Allopathic & Osteopathic Physicians |
| N | 207RI0011X |
Internal Medicine Specialization: Interventional Cardiology |
0004705 | IL | Allopathic & Osteopathic Physicians |
| N | 2085R0001X |
Radiology Specialization: Radiation Oncology |
0004705 | IL | Allopathic & Osteopathic Physicians |
| N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
0004705 | IL | Allopathic & Osteopathic Physicians |
| N | 227800000X | Respiratory Therapist, Certified | 0004705 | IL | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| N | 227900000X | Respiratory Therapist, Registered | 0004705 | IL | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Y | 207P00000X | Emergency Medicine | 0004705 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | GROUP HEALTH PLAN | 33898 | 01 |
| IL | BLUE CROSS BLUE SHIELD | 4115179 | 01 |
| Other Name | Type Code |
|---|---|
| SSM Health Good Samaritan Hospital - Mt. Vernon | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194269597 | Good Samaritan Regional Health Center | Anesthesiology | 1 Good Samaritan Way, Mount Vernon, IL 62864-2402 | 2016-12-05 |
| 1316282163 | Good Samaritan Regional Health Center | Pharmacy | 2 Good Samaritan Way, Suite 120, Mount Vernon, IL 62864-2475 | 2012-12-05 |
| 1134457955 | Good Samaritan Regional Health Center | Specialist | 1 Good Samaritan Way, Mount Vernon, IL 62864-2402 | 2009-12-07 |
| 1609897339 | Good Samaritan Regional Health Center | Psychiatric Unit | 1 Good Samaritan Way, Mount Vernon, IL 62864-2402 | 2006-07-21 |
| 1043270424 | Good Samaritan Regional Health Center | Rehabilitation Unit | 1 Good Samaritan Way, Mount Vernon, IL 62864-2402 | 2006-03-28 |
| Street Address |
1 GOOD SAMARITAN WAY |
| City | MOUNT VERNON |
| State | IL |
| Zip Code | 62864-2402 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083609184 | Kent S Quinn | Radiology | 1 Good Samaritan Way, Attn Radiology Dept, Mount Vernon, IL 62864-2402 | 2005-09-14 |
| 1407470206 | Brittany L Jerger | Registered Nurse | 1 Good Samaritan Way, Mount Vernon, IL 62864-2402 | 2020-06-08 |
| 1407418619 | Annie Rae Lowery | Registered Nurse | 1 Good Samaritan Way, Mount Vernon, IL 62864-2402 | 2019-07-08 |
| 1366951436 | Roxanna Elise Stevens | Nurse Practitioner | 1 Good Samaritan Way, Mount Vernon, IL 62864-2402 | 2017-09-21 |
| 1871022095 | Mathavi Sahadevan | Internal Medicine | 1 Good Samaritan Way, Mount Vernon, IL 62864-2402 | 2017-06-09 |
| 1326589680 | Amber Dawn Willis | Nurse Practitioner | 1 Good Samaritan Way, Mount Vernon, IL 62864-2402 | 2017-03-19 |
| 1194269597 | Good Samaritan Regional Health Center | Anesthesiology | 1 Good Samaritan Way, Mount Vernon, IL 62864-2402 | 2016-12-05 |
| 1710439112 | Nicole Michelle Boyd | Nurse Practitioner | 1 Good Samaritan Way, Mount Vernon, IL 62864-2402 | 2016-11-01 |
| 1588115810 | Cristina Myers | Nurse Practitioner | 1 Good Samaritan Way, Mount Vernon, IL 62864-2402 | 2016-10-21 |
| 1144771692 | Misty Dawn Wernsman | Nurse Practitioner | 1 Good Samaritan Way, Mount Vernon, IL 62864-2402 | 2016-10-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619438892 | Melissa Pryer | Dietitian, Registered | 2020 Broadway, Suite 1, Mt. Vernon, IL 62864 | 2019-03-28 |
| 1487145454 | Chiropractic Wellness Center of Mt Vernon, LLC. | Chiropractor | 1009 S 42nd St Ste 5, Mount Vernon, IL 62864 | 2018-05-24 |
| 1851889208 | Kimberly Tate | Counselor | 4110 North Water Place, Mt. Vernon, IL 62864 | 2018-05-01 |
| 1871907790 | University Hematology Oncology Inc | Specialist | #11 Cusumano Professional Plaza, Mount Vernon, IL 62864 | 2014-06-18 |
| 1457771677 | Dynamic Counseling and Consultation Services | Social Worker | 3600 S Water Tower Pl, Mt Vernon, IL 62864 | 2014-04-27 |
| 1619239431 | Judith C Morgan | Counselor | 16338 N Illinois Hwy 37, Mount Vernon, IL 62864 | 2012-06-08 |
| 1073888624 | James Brian Verges | Counselor | 16338 N. Illinois Hwy 37, Mount Vernon, IL 62864 | 2012-03-15 |
| 1720352271 | Lucinda M. Holdren | Counselor | 16338 North Illinois Highway 37, Mount Vernon, IL 62864 | 2012-03-01 |
| 1780978627 | Jamie M Orange | Physical Therapy Assistant | 19958 Fairfield Rd, Mt. Vernon, IL 62864 | 2011-06-08 |
| 1780978791 | Wendy Marie Claytor | Speech-Language Pathologist | 600 E Il Hwy 15, Mount Vernon, IL 62864 | 2011-06-07 |
| Find all providers in zip 62864 | ||||
| Taxonomy Code | 207P00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: mofified source] - Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649298779 | Michael Kevin Rowe | Emergency Medicine | 140 Newcomb Ave, Mount Vernon, KY 40456-2728 | 2006-07-17 |
| 1053343012 | Jeffrey S Gusky | Emergency Medicine | 500 S. State Hwy 37, Mount Vernon, TX 75457 | 2006-07-07 |
| 1740210749 | James F Neuenschwander II | Emergency Medicine | 1330 Coshocton Rd, Knox Community Hospital, Mount Vernon, OH 43050-1440 | 2006-07-04 |
| 1821027285 | Samuel N. Mark | Emergency Medicine | C/o Dr Abdulla. Medical Clinic, 12 North 7th Ave, Mount Vernon, NY 10550 | 2006-06-30 |
| 1316983109 | William F. Stewart | Emergency Medicine | 140 Newcomb Ave Ste 1, Mount Vernon, KY 40456-2726 | 2006-06-21 |
| 1366486235 | Christie Foster | Emergency Medicine | 1104 S 42nd St, Mount Vernon, IL 62864-6216 | 2006-06-15 |
| 1477510493 | Larry Ralph Nelson | Emergency Medicine | 809 S 15th St, Mount Vernon, WA 98274-4564 | 2006-04-26 |
| 1386607612 | Jena Marie Lopez | Emergency Medicine | 1415 E Kincaid Street, Mount Vernon, WA 98274-4126 | 2006-04-08 |
| 1801867205 | Robert F White | Emergency Medicine | 416 Kaufman St N, Mount Vernon, TX 75457-2116 | 2006-02-01 |
| 1821442179 | Midwest Emergency Good Samaritan | Emergency Medicine | 1 Good Samaritan Way, Mount Vernon, IL 62864-2402 | 2016-04-22 |
| Find all providers in MOUNT VERNON | ||||
| City | MOUNT VERNON |
| Zip Code | 62864 |
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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.