ST. MARY MEDICAL CENTER (NPI# 1669456299) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669456299 |
| Entity Type | Organization |
| Organization Name | ST. MARY MEDICAL CENTER |
| Other Organization Name | ST. MARY REGIONAL MEDICAL CENTER |
| Practice Address |
18300 Highway 18 Apple Valley CA 92307 |
| Practice Telephone | 7602422311 |
| Practice Fax Number | 7609468824 |
| Mailing Telephone | 7602422311 |
| Mailing Fax Number | 7609468824 |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2015-08-12 |
| Authorized Official Name | ALAN H. GARRETT (PRESIDENT AND CEO) |
| Authorized Official Telephone | 7602422311 |
| Authorized Official Credential | CPA |
| Is Organization Subpart | Y |
| Parent Organization Name | ST. JOSEPH HEALTH SYSTEM |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 282N00000X | General Acute Care Hospital | 240000207 | CA | Hospitals |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | ZZT40300F | 05 | |
| CA | ZZT30300F | 05 |
| Other Name | Type Code |
|---|---|
| St. Mary Regional Medical Center | Former Legal Business Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285007419 | St. Mary Medical Center | Clinic/Center | 1045 Atlantic Ave, Suite 914, Long Beach, CA 90813-3408 | 2015-11-10 |
| 1740698497 | St. Mary Medical Center | General Acute Care Hospital | 1707 N Henderson St, Galesburg, IL 61401-1320 | 2014-07-25 |
| 1487078796 | St. Mary Medical Center | Ambulance | 1201 Langhorne Newtown Rd, Langhorne, PA 19047-1201 | 2014-02-06 |
| 1043406440 | St. Mary Medical Center | Advanced Practice Midwife | 18077 Us Highway 18, Apple Valley, CA 92307-2150 | 2007-09-19 |
| 1982899266 | St. Mary Medical Center | General Acute Care Hospital | 401 W Poplar St, Walla Walla, WA 99362-2846 | 2007-09-11 |
| 1700921541 | St. Mary Medical Center | Internal Medicine | 2241 45th St, Highland, IN 46322-2601 | 2007-02-20 |
| 1952458564 | St. Mary Medical Center | Nurse Anesthetist, Certified Registered | 1500 S Lake Park Ave, Hobart, IN 46342-6638 | 2007-01-04 |
| 1457425605 | St. Mary Medical Center | Internal Medicine | 300 W 80th Pl, Ste A, Merrillville, IN 46410-5456 | 2006-11-20 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | ST. MARY MEDICAL CENTER | 1201 Langhorne - Newtown Rd, Langhorne, PA 19047-1201 |
| Washington State Corporations | ST. MARY MEDICAL CENTER | 401 W Poplar St, Walla Walla, WA 99362 |
| Indiana Business Entities | ST. MARY MEDICAL CENTER DEVELOPMENT, LLC | St. Mary Medical Center, 1500 S. Lake Park Ave., Hobart, IN 46342 |
| System for Award Management (SAM) Entities | ST. MARY MEDICAL CENTER FOUNDATION | 1050 Linden Ave, Long Beach, CA 90813-3321 |
| System for Award Management (SAM) Entities | ST. MARY MEDICAL CENTER, INC. | 1500 S Lake Park Ave, Hobart, IN 46342-6638 |
| Street Address |
18300 HIGHWAY 18 |
| City | APPLE VALLEY |
| State | CA |
| Zip Code | 92307 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972919876 | Joseph P. Casas | Physician Assistant | 18300 Highway 18, Apple Valley, CA 92307 | 2014-07-11 |
| 1588991822 | Brandy R Henson | Physician Assistant | 18300 Highway 18, Apple Valley, CA 92307 | 2009-11-06 |
| 1831424506 | Arshad Aziz Samad | Physician Assistant | 18300 Highway 18, Apple Valley, CA 92307-0725 | 2009-10-13 |
| 1023155934 | Randhir Kaboo | Anesthesiology | 18300 Highway 18, Apple Valley, CA 92307-2206 | 2007-01-31 |
| 1477636207 | Steven Jeffrey Dodds | Pediatrics | 18300 Highway 18, Apple Valley, CA 92307-2206 | 2006-10-23 |
| 1063515187 | Kimberly Kay Tillotson | Advanced Practice Midwife | 18300 Highway 18, Apple Valley, CA 92307-2215 | 2006-09-06 |
| 1548373285 | John Calvert Butcher | Nurse Anesthetist, Certified Registered | 18300 Highway 18, Apple Valley, CA 92307-2206 | 2006-08-16 |
| 1215944350 | April P Popejoy | Dietitian, Registered | 18300 Highway 18, Apple Valley, CA 92307 | 2006-08-02 |
| 1194761122 | Eugene Wen-chun Hu | Emergency Medicine | 18300 Highway 18, Apple Valley, CA 92307 | 2006-06-20 |
| 1518902386 | Daniel Lumucso Quion | Emergency Medicine | 18300 Highway 18, Apple Valley, CA 92307 | 2006-06-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679106025 | Rajender S. Thakran, M.d., Inc | Specialist | 16030 Kamana Rd, Apple Valley, CA 92307 | 2020-02-13 |
| 1477119980 | Harpreet Singh | Nurse Practitioner | 18300 Ca-18, Apple Valley, Ca 92307, Apple Valley, CA 92307 | 2019-05-10 |
| 1184120784 | Frantz Jean-louis | Nurse Practitioner | 16134 Muni Rd, Apple Valley, CA 92307 | 2018-04-03 |
| 1053862078 | Ashley M Morello | Registered Nurse | Universal Pain Management, 16179 Siskiyou, Apple Valley, CA 92307 | 2016-10-14 |
| 1891191680 | Ann Simonds | Marriage & Family Therapist | 20601 Us Highway 18 Ste 123, Apple Valley, CA 92307 | 2014-11-06 |
| 1396147419 | Aaa Family Medical Group | Family Medicine | 15995 Tuscola Rd Ste 202, Apple Valley, CA 92307 | 2014-09-19 |
| 1659780534 | Relena Tran | Pharmacist | 20251 Highway 18, Apple Valley, CA 92307 | 2014-08-05 |
| 1639508526 | Meagan Katherine Blades | Physician Assistant | 18300 Outer Hwy 18, Apple Valley, CA 92307 | 2013-11-01 |
| 1720341555 | Jonathan Robert Cox | Dermatology | 18523 Corwin Rd Ste G, Apple Valley, CA 92307 | 2012-06-18 |
| 1821364365 | Leary Sport and Spine Chiropractic Inc. | Chiropractor | 18564 Us Highway 18 Suite, 303, Apple Valley, CA 92307 | 2012-03-29 |
| Find all providers in zip 92307 | ||||
| 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 |
|---|---|---|---|---|
| 1699950733 | Sri Md, Inc | General Acute Care Hospital | 18564 Highway 18, Suite# 105, Apple Valley, CA 92307-2312 | 2008-01-08 |
| 1710109186 | St Mary Medical Center | General Acute Care Hospital | 18300 Us Highway 18, Apple Valley, CA 92307-2206 | 2007-05-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437763224 | Mola Medical Practice Inc | General Acute Care Hospital | 6906 Treasure Trl, Los Angeles, CA 90068-1838 | 2020-08-31 |
| 1497376966 | Barton Ambulatory Clinics | General Acute Care Hospital | 2170 South Ave Ste B, South Lake Tahoe, CA 96150-7026 | 2020-05-06 |
| 1346723194 | Eisenhower Medical Center | General Acute Care Hospital | 1401 North Palm Canyon Drive, Suite #202, Palm Springs, CA 92262 | 2018-09-07 |
| 1699282285 | Kern County Hospital Authority | General Acute Care Hospital | 6001 Truxtun Ave Ste 210, Bakersfield, CA 93309-0662 | 2018-01-04 |
| 1598272577 | Eisenhower Medical Center | General Acute Care Hospital | 74020 Alessandro Drive, Suite B, Palm Desert, CA 92260 | 2017-12-29 |
| 1720597511 | Children's Recovery Center 1, LLC | General Acute Care Hospital | 3777 S Bascom Ave, Campbell, CA 95008-7320 | 2017-09-25 |
| 1336668284 | Kern County Hospital Authority | General Acute Care Hospital | 2920 F St Ste B1, Bakersfield, CA 93301-1829 | 2017-09-12 |
| 1821524315 | Azadeh Salek | General Acute Care Hospital | 308 Paseo De La Playa Apt 4, Redondo Beach, CA 90277-6251 | 2017-05-03 |
| 1790210359 | Va Hospital Mather | General Acute Care Hospital | 3131 Sparrow Dr, Sacramento, CA 95834-2639 | 2017-04-20 |
| 1881127041 | Chad William Downing | General Acute Care Hospital | 28003 Via Del Agua, Laguna Niguel, CA 92677-7359 | 2017-04-05 |
| Find all providers with the same taxonomy | ||||
| City | APPLE VALLEY |
| Zip Code | 92307 |
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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.