ST JOSEPH MEDICAL CENTER (NPI# 1871547414) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871547414 |
| Entity Type | Organization |
| Organization Name | ST JOSEPH MEDICAL CENTER |
| Other Organization Name | OSFMG - BLOOMINGTON |
| Practice Address |
302 Saint Joseph Dr Bloomington IL 61701-3506 |
| Mailing Address |
Po Box 1712 Peoria IL 61656-1712 |
| Practice Telephone | 8005896070 |
| Practice Fax Number | 3096835969 |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2010-05-05 |
| Authorized Official Name | DR. GERALD J. MCSHANE (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 3096557193 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | Y |
| Parent Organization Name | OSF HEALTHCARE SYSTEM |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RS0012X |
Internal Medicine Specialization: Sleep Medicine |
036-092200 | IL | Allopathic & Osteopathic Physicians |
| N | 208600000X | Surgery | Allopathic & Osteopathic Physicians | ||
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 2081P2900X |
Physical Medicine & Rehabilitation Specialization: Pain Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 207RR0500X |
Internal Medicine Specialization: Rheumatology |
Allopathic & Osteopathic Physicians | ||
| N | 207RP1001X |
Internal Medicine Specialization: Pulmonary Disease |
Allopathic & Osteopathic Physicians | ||
| N | 207V00000X | Obstetrics & Gynecology | Allopathic & Osteopathic Physicians | ||
| N | 213E00000X | Podiatrist | Podiatric Medicine & Surgery Service Providers | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BLUE SHIELD | 5723443 | 01 |
| Other Name | Type Code |
|---|---|
| OSFMG - Bloomington | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851330203 | St Joseph Medical Center | Home Health | 211 Landmark Dr, Suite D3, Normal, IL 61761-2160 | 2006-06-04 |
| 1679012710 | St Joseph Medical Center | General Acute Care Hospital | 8441 State Highway 47, Suite 4300, Bryan, TX 77807-3207 | 2017-02-22 |
| 1336465004 | St Joseph Medical Center | General Acute Care Hospital | 1717 S J St, Tacoma, WA 98405-4933 | 2010-04-20 |
| 1174758346 | St Joseph Medical Center | Radiology | 407 E Vernon Ave, Normal, IL 61761-3813 | 2009-05-18 |
| 1902066400 | St Joseph Medical Center | Preventive Medicine | 1505 Eastland Dr, Suite 1000, Bloomington, IL 61701-3534 | 2008-06-10 |
| 1659552859 | St Joseph Medical Center | Emergency Medicine | 2200 E Washington St, Bloomington, IL 61701-4364 | 2007-11-16 |
| 1881782878 | St Joseph Medical Center | Internal Medicine | 1505 Eastland Dr, Suite 110, Bloomington, IL 61701-3534 | 2006-10-11 |
| 1184732851 | St Joseph Medical Center | General Acute Care Hospital | 2200 E Washington St, Bloomington, IL 61701-4364 | 2006-08-25 |
| 1932148236 | St Joseph Medical Center | Skilled Nursing Facility | 2200 E Washington St, Bloomington, IL 61701-4364 | 2006-06-05 |
| 1619916806 | St Joseph Medical Center | General Acute Care Hospital | 2200 E Washington St, Bloomington, IL 61701-4364 | 2006-06-05 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | ST JOSEPH MEDICAL CENTER | 1717 S J St, Tacoma, WA 98405-4933 |
| Street Address |
302 SAINT JOSEPH DR |
| City | BLOOMINGTON |
| State | IL |
| Zip Code | 61701-3506 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487012860 | Samina Yousuf | Pediatrics | 302 Saint Joseph Dr, Bloomington, IL 61701-3506 | 2016-02-01 |
| 1972681245 | Kristen Braun | Nurse Practitioner | 302 Saint Joseph Dr, Bloomington, IL 61701-3506 | 2006-11-02 |
| 1588756134 | Blair Valentine | Internal Medicine | 302 Saint Joseph Dr, Bloomington, IL 61701-3506 | 2006-09-29 |
| 1992804793 | Maria Rosa | Pediatrics | 302 Saint Joseph Dr, Bloomington, IL 61701-3506 | 2006-09-21 |
| 1144331828 | Stephen Trainor | Pediatrics | 302 Saint Joseph Dr, Bloomington, IL 61701-3506 | 2006-08-31 |
| 1215947171 | Lori L Pegram | Internal Medicine | 302 Saint Joseph Dr, Bloomington, IL 61701-3506 | 2006-08-09 |
| 1275559270 | Jodie Dewey | Pediatrics | 302 Saint Joseph Dr, Bloomington, IL 61701-3506 | 2006-07-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770140964 | County of Mclean | Community/Behavioral Health | 200 W Front St, 1st Floor Sw, C/o 200 W Front St, Suite 400f, Bloomington, IL 61701 | 2019-05-22 |
| 1023525292 | Karli Johnson | Counselor | 200 W Monroe St Ste C7, Bloomington, IL 61701 | 2018-01-09 |
| 1487172409 | Melody Ann Bauman | Physician Assistant | 1505 Eastland Dr, Osf Critical Cane, Pulmonary, Sleep M, Bloomington, IL 61701 | 2017-08-30 |
| 1215396288 | Heidi Larsen | Social Worker | 902 S East St, Bloomington, IL 61701 | 2016-02-18 |
| 1558735126 | Andrea E. Andrews Counseling LLC | Counselor | 200 W. Monroe St., Ste 302 C, Bloomington, IL 61701 | 2015-11-19 |
| 1174924856 | Carole Hahn | Dietitian, Registered | 1406 Forrest St, Bloomington, IL 61701 | 2014-09-12 |
| 1558786392 | Valerie Colleen Parker | Counselor | 109 W. Mulberry St., Bloomington, IL 61701 | 2014-03-04 |
| 1124459219 | Matilde Francois | Surgery | 1505 Eastland Dr Ste 2300, Bloomington, IL 61701 | 2013-11-27 |
| 1922435114 | Smitha H Shivaprasad | Pharmacist | 2611 East Oakland Avenue, Bloomington, IL 61701 | 2013-10-02 |
| 1295161941 | Ashvin Patel | Obstetrics & Gynecology | 31 Country Club Pl, Bloomington, IL 61701 | 2013-09-25 |
| Find all providers in zip 61701 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073165650 | Genevieve Elon Monge | Family Medicine | 18651 Valley Blvd, Bloomington, CA 92316-1831 | 2019-07-12 |
| 1982117172 | Andry Medical Services | Family Medicine | 451 S Park Ridge Rd Ste 101, Bloomington, IN 47401-8589 | 2017-11-09 |
| 1033459904 | Charles R Farmer | Family Medicine | 3480 S Oak Ridge Dr, Bloomington, IN 47401-8926 | 2013-02-28 |
| 1467798504 | James Anthony Ray | Family Medicine | 2001 E Hillside Dr Lot 4, Bloomington, IN 47401-6692 | 2012-12-18 |
| 1902140585 | Fountain Healthcare Limited Liability Company | Family Medicine | 2412 E Washington St Ste 6, Bloomington, IL 61704-4497 | 2012-11-20 |
| 1306147236 | Community Health Network | Family Medicine | 524 N Fairview St, Bloomington, IN 47404-3774 | 2010-11-09 |
| 1942501978 | Premier Medical Group, LLC | Family Medicine | 2102 E Washington St, Bloomington, IL 61701-4321 | 2010-11-08 |
| 1356660666 | Glen Edward Tomlinson | Family Medicine | 42 Crista Ann Ct, Bloomington, IL 61704-8699 | 2010-05-26 |
| 1285862664 | Charles W Mcclary | Family Medicine | 1411 S Sare Rd, Bloomington, IN 47401-4431 | 2009-06-24 |
| 1982840005 | Thomas Patterson Cairns | Family Medicine | 10258 Berkshire Rd, Bloomington, MN 55437-2265 | 2008-12-18 |
| Find all providers in BLOOMINGTON | ||||
| City | BLOOMINGTON |
| Zip Code | 61701 |
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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.