SSM MEDICAL GROUP (NPI# 1770789984) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770789984 |
| Entity Type | Organization |
| Organization Name | SSM MEDICAL GROUP |
| Other Organization Name | SSM MEDICAL GROUP DBA JOSEPH C. RUDOLPH, M.D. |
| Practice Address |
1747 Smizer Station Rd Suite 6 Fenton MO 63026-2784 |
| Practice Telephone | 6362257908 |
| Practice Fax Number | 6362257497 |
| Mailing Telephone | 6362257908 |
| Mailing Fax Number | 6362257497 |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MRS. DEBORAH B. REICHARDT (OFFICE MANAGER) |
| Authorized Official Telephone | 6362257908 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | INDIVIDUAL NPI | 1376561464 | 01 |
| Other Name | Type Code |
|---|---|
| SSM Medical Group DBA Joseph C. Rudolph, M.D. | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275781288 | Ssm Medical Group | Family Medicine | 1011 Bowles Ave, Suite 300, Fenton, MO 63026-2387 | 2008-09-03 |
| 1538342621 | Ssm Medical Group | Clinic/Center | 6828 State Route 162, Maryville, IL 62062-8500 | 2007-12-11 |
| 1619150703 | Ssm Medical Group | Clinic/Center | 3 Park Pl, Swansea, IL 62226-2965 | 2007-12-11 |
| 1144402660 | Ssm Medical Group | Clinic/Center | 1031 Bellevue Ave, Suite 300, Saint Louis, MO 63117-1818 | 2007-11-27 |
| 1053593541 | Ssm Medical Group | Clinic/Center | 1035 Bellevue Ave, Suite 502, Saint Louis, MO 63117-1854 | 2007-11-27 |
| 1013199504 | Ssm Medical Group | Clinic/Center | 1035 Bellevue Ave, Suite 305, Saint Louis, MO 63117-1854 | 2007-11-27 |
| 1760663447 | Ssm Medical Group | Clinic/Center | 6400 Clayton Rd, Suite 216, Saint Louis, MO 63117-1850 | 2007-11-21 |
| 1023297637 | Ssm Medical Group | Pediatrics | 4116 Von Talge Rd, Saint Louis, MO 63128-1957 | 2007-10-31 |
| 1649459215 | Ssm Medical Group | Clinic/Center | 20 The Legends Pkwy, Suite 100, Eureka, MO 63025-3821 | 2007-10-30 |
| 1023218898 | Ssm Medical Group | Internal Medicine | 1011 Bowles Ave, Suite 300, Fenton, MO 63026-2387 | 2007-07-20 |
| Street Address |
1747 SMIZER STATION RD SUITE 6 |
| City | FENTON |
| State | MO |
| Zip Code | 63026-2784 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134104466 | Brenda Lynn Buckley | Family Medicine | 1747 Smizer Station Rd, Suite 5, Fenton, MO 63026-2784 | 2005-12-09 |
| 1588285431 | Alisa M Perozo-dickerson | Advanced Practice Midwife | 1747 Smizer Station Rd, Fenton, MO 63026-2784 | 2020-05-01 |
| 1891238291 | Amber Lee Sorcic | Chiropractor | 1747 Smizer Station Rd, St. 4, Fenton, MO 63026-2784 | 2016-12-02 |
| 1346795234 | Chiropractic Wellness Center | Chiropractor | 1747 Smizer Station Rd, Fenton, MO 63026-2784 | 2016-08-20 |
| 1255613642 | Metro Foot Specialists, LLC | Podiatrist | 1747 Smizer Station Rd, Suite 3a, Fenton, MO 63026-2784 | 2011-09-13 |
| 1508158445 | Chiropractic Wellness Center of St Louis LLC | Clinic/Center | 1747 Smizer Station Rd, Ste. 4, Fenton, MO 63026-2784 | 2011-05-11 |
| 1255632238 | Lorenelle Lofquist | Chiropractor | 1747 Smizer Station Rd, Ste 4, Fenton, MO 63026-2784 | 2010-11-08 |
| 1023280856 | Rockwood Family Medicine LLC | Family Medicine | 1747 Smizer Station Rd, Suite 3b, Fenton, MO 63026-2784 | 2008-04-01 |
| 1629295712 | Saint Louis University Dba Mark Herbers, M.d. | Pediatrics | 1747 Smizer Station Rd, Suite 6, Fenton, MO 63026-2784 | 2007-04-19 |
| 1356493811 | Fenton Family Practice, LLC | Specialist | 1747 Smizer Station Rd, Suite 5, Fenton, MO 63026-2784 | 2007-01-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871000372 | Allison Egler | Audiologist | 1011 Bowles Ave Ste 405, Fenton, MO 63026 | 2018-01-05 |
| 1629508213 | Holly Brooks Munson | Massage Therapist | 220 Copper Mountain Dr, Fenton, MO 63026 | 2017-06-15 |
| 1073978862 | Naomi Sharon | Nurse Practitioner | 1101 Bowles Avenue, Suite G50, Fenton, MO 63026 | 2015-12-21 |
| 1871981704 | Celtic Private Care of Il & Mo, LLC | In Home Supportive Care | 1653 Larkin Williams Road, Suite 201, Fenton, MO 63026 | 2014-12-30 |
| 1356747513 | Kristina Potts | Nurse Practitioner | 774 Gravois Bluffs Blvd Ste B, Fenton, MO 63026 | 2014-11-14 |
| 1245642420 | Physicians Health Group Medical Inc | General Practice | 960 S. Highway Dr, Fenton, MO 63026 | 2014-05-22 |
| 1598047409 | Kevin Eugene Bruce | Pharmacist | 1210 Sugar Creek, Fenton, MO 63026 | 2011-09-16 |
| 1215186382 | Concentra Health Services, Inc. | Clinic/Center | 128 Matrix Commons Dr., Fenton, MO 63026 | 2008-09-15 |
| 1790954410 | Castlewood Treatment Center LLC | Community/Behavioral Health | 1855 Bowles Ave, Suite 210, Fenton, MO 63026 | 2008-02-27 |
| 1073703617 | Christina R Baeres | Dietitian, Registered | 38 Majestic Ct, Fenton, MO 63026 | 2007-07-30 |
| Find all providers in zip 63026 | ||||
| Taxonomy Code | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
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|---|---|---|---|---|
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| 1437569647 | Therapy Support Center LLC | Clinic/Center | 113 North River Street, Fenton, MI 48430 | 2014-04-28 |
| 1760953095 | Wuca-fenton Pediatrics, LLC | Clinic/Center | 714 Gravois Rd Ste 200, Fenton, MO 63026-7723 | 2018-12-16 |
| 1750664991 | Fenton Vision Sensory and Learning Center Pllc | Clinic/Center | 1535 N Leroy St, Suite D, Fenton, MI 48430-2791 | 2011-09-23 |
| 1700966207 | Ssm Medical Group, Inc. | Clinic/Center | 1011 Bowles Ave, Suite 300, Fenton, MO 63026-2395 | 2006-10-17 |
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| 1619513215 | Southeast Missouri Health Network | Clinic/Center | 835 W Murray Ln, Sikeston, MO 63801-4056 | 2019-11-19 |
| 1275014953 | Arch Pediatrics LLC | Clinic/Center | 3844 S Lindbergh Blvd Ste 216, Saint Louis, MO 63127-1369 | 2018-08-22 |
| 1174015515 | Washington University Physicians In Illinois, Inc | Clinic/Center | 4511 Forest Park Ave, Saint Louis, MO 63108-2138 | 2018-06-01 |
| 1164921300 | Texas County Memorial Hospital | Clinic/Center | 1333 S Sam Houston Blvd Ste A, Houston, MO 65483 | 2018-02-02 |
| 1053822650 | Edge Medical Services Inc. | Clinic/Center | 105 W 34th St Apt 2, Kansas City, MO 64111-1677 | 2017-10-23 |
| 1932618394 | United Physicians Group, LLC | Clinic/Center | 14825 N Outer 40 Rd Ste 365, Chesterfield, MO 63017-2152 | 2017-09-28 |
| 1073022000 | Fairview Heights Medical Group Sc | Clinic/Center | 670 Mason Ridge Center Dr Ste 300, Saint Louis, MO 63141-8573 | 2017-09-21 |
| 1013433762 | Elevating Care Clinic, LLC | Clinic/Center | 2340 E. Meyer Blvd, 208, Kansas City, MO 64132-1105 | 2017-08-15 |
| Find all providers with the same taxonomy | ||||
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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.