GOOD SAMARITAN REGIONAL HEALTH CENTER (NPI# 1609897339) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609897339 |
| 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 |
| Mailing Telephone | 6188994600 |
| Enumeration Date | 2006-07-21 |
| 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 | 273R00000X | Psychiatric Unit | 0004705 | IL | Hospital Units |
| Y | 282N00000X | General Acute Care Hospital | 0004705 | IL | Hospitals |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BLUE CROSS/BLUE SHIELD | 0014 | 01 |
| IL | GROUP HEALTH PLAN NUMBER | 33898 | 01 |
| IL | BLACK LUNG NUMBER | 39584100 | 01 |
| IL | HEALTH ALLIANCE NUMBER | 003891 | 01 |
| IL | HEALTHLINK NUMBER | 103233 | 01 |
| IL | ACS OWCP NUMBER | 140112100 | 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 |
| 1487758801 | Good Samaritan Regional Health Center | Physical Medicine & Rehabilitation | 1 Good Samaritan Way, Mount Vernon, IL 62864-2402 | 2006-09-08 |
| 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 | 282N00000X |
| Grouping | Hospitals |
| Classification | General Acute Care Hospital |
| An acute general hospital is an institution whose primary function is to provide inpatient diagnostic and therapeutic services for a variety of medical conditions, both surgical and non-surgical, to a wide population group. The hospital treats patients in an acute phase of illness or injury, characterized by a single episode or a fairly short duration, from which the patient returns to his or her normal or previous level of activity. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720471824 | Haydar Al-dabbagh | General Acute Care Hospital | 660 Locust St Apt B7, Mount Vernon, NY 10552-2663 | 2015-03-13 |
| 1194807438 | East Texas Medical Center Mount Vernon | General Acute Care Hospital | 500 Hwy 37 S, Mount Vernon, TX 75457-6550 | 2006-10-19 |
| 1205821113 | East Texas Medical Center Mount Vernon | General Acute Care Hospital | 500 South State Highway 37, Mount Vernon, TX 75457-6550 | 2005-09-16 |
| 1306260211 | Montefiore Mount Vernon Hospital | General Acute Care Hospital | 12 N 7th Ave, Mount Vernon, NY 10550-2026 | 2014-02-12 |
| 1356619761 | The Mount Vernon Hospital | General Acute Care Hospital | 12 N 7th Ave, Mount Vernon East, Mount Vernon, NY 10550-2026 | 2011-12-13 |
| 1326374810 | Act & Icm/scm | General Acute Care Hospital | 12 N 7th Ave, Mount Vernon, NY 10550-2026 | 2009-10-19 |
| 1346399037 | Mount Vernon Hospital | General Acute Care Hospital | 12 N 7th Ave, Mount Vernon, NY 10550-2026 | 2007-01-10 |
| 1295761963 | Knox Community Hospital | General Acute Care Hospital | 1330 Coshocton Ave, Mount Vernon, OH 43050-1440 | 2006-06-24 |
| 1053357244 | Public Hospital Dist No 1 Skagit | General Acute Care Hospital | 1415 E Kincaid St, Mount Vernon, WA 98274-4126 | 2006-06-22 |
| 1750353041 | National Healthcare of Mt Vernon Inc | General Acute Care Hospital | 8 Doctors Park Rd, Mount Vernon, IL 62864-6224 | 2006-02-02 |
| 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.