SSM DEPAUL MEDICAL GROUP (NPI# 1891123477) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891123477 |
| Entity Type | Organization |
| Organization Name | SSM DEPAUL MEDICAL GROUP |
| Practice Address |
1551 Wall St Suite 400 Saint Charles MO 63303-3539 |
| Mailing Address |
1551 Wall St Suite 310 Saint Charles MO 63303-3539 |
| Practice Telephone | 6366692420 |
| Practice Fax Number | 6366692401 |
| Mailing Telephone | 6366692268 |
| Mailing Fax Number | 3142098127 |
| Enumeration Date | 2013-10-17 |
| Last Update Date | 2013-10-17 |
| Authorized Official Name | LAURA PULLUM (DIRECTOR) |
| Authorized Official Telephone | 6366692434 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207QA0505X |
Family Medicine Specialization: Adult Medicine |
Allopathic & Osteopathic Physicians | ||
| Y | 213E00000X | Podiatrist | 2004019662 | MO | Podiatric Medicine & Surgery Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174962922 | Ssm Depaul Medical Group | Orthopaedic Surgery | 12266 Depaul Drive, Suite 110, Bridgeton, MO 63044-2514 | 2013-06-14 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | SSM DEPAUL MEDICAL GROUP, INC. | 10101 Woodfield Ln, Saint Louis, MO 63132-2937 |
| Street Address |
1551 WALL ST SUITE 400 |
| City | SAINT CHARLES |
| State | MO |
| Zip Code | 63303-3539 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184685547 | Nadira Adil | Pediatrics | 1551 Wall St, 4th Floor, Saint Charles, MO 63303-3539 | 2006-03-28 |
| 1235599341 | Chalenna C. Cassell | Psychologist | 1551 Wall St, Saint Charles, MO 63303-3539 | 2016-03-02 |
| 1245699578 | Kimberly A Franer | Nurse Practitioner | 1551 Wall St, Suite 400, Saint Charles, MO 63303-3539 | 2016-02-15 |
| 1083072946 | Shannon Haselhorst | Physical Therapist | 1551 Wall St, Suite 110, Saint Charles, MO 63303-3539 | 2016-02-08 |
| 1144653049 | Tyler Nicholas Forbes | Physical Therapist | 1551 Wall St, Suite 110, Saint Charles, MO 63303-3539 | 2013-08-14 |
| 1316370224 | Patrick Daniel Fagan | Physical Therapist | 1551 Wall St, Suite 110, Saint Charles, MO 63303-3539 | 2013-08-14 |
| 1770827321 | Paula J Musgrove | Physical Therapist | 1551 Wall St, Saint Charles, MO 63303-3539 | 2012-11-20 |
| 1457660896 | Ssmdepaul Medical Group | Family Medicine | 1551 Wall St, Suite 400, Saint Charles, MO 63303-3539 | 2010-10-04 |
| 1871808147 | Todd Abramczyk | Physical Therapist | 1551 Wall St, Saint Charles, MO 63303-3539 | 2010-08-11 |
| 1053639211 | Andrea Lynn Montgomery | Physical Therapist | 1551 Wall St, Saint Charles, MO 63303-3539 | 2010-05-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083214787 | Michael Frederick | Pharmacist | 2855 Veterans Memorial Parkway, (pharmacy), Saint Charles, MO 63303 | 2020-10-30 |
| 1710525639 | Cheryl Ann O'dell | Pharmacist | Schnucks Pharmacy, 60 Harvester Square, St Charles, MO 63303 | 2019-12-11 |
| 1255821302 | Melinda R Winfield | Nurse Practitioner | 1313 Park Ct, Saint Charles, MO 63303 | 2018-05-15 |
| 1467904839 | Heather Lilledahl | Speech-Language Pathologist | 2800 Old Muegge Road, Saint Charles, MO 63303 | 2016-11-01 |
| 1437608312 | Preferred Family Healthcare | Counselor | 1559 Old S. River Road, St.charles, MO 63303 | 2016-10-03 |
| 1487109146 | Annette Patricia Davenport | Nurse Practitioner | 1551 Wall Street, Logistics Health Inc, Suite 100, Saint Charles, MO 63303 | 2016-08-23 |
| 1053762328 | Sarah Biondo | Speech-Language Pathologist | 7204 Fountainview Circle, Ofallon, MO 63303 | 2016-06-28 |
| 1710331335 | Lindsey Ann Eilers | Counselor | 1570 South Main, Saint Charles, MO 63303 | 2016-04-20 |
| 1174914600 | Jacquelyn Michele Miller | Pharmacy Technician | 3881 Mexico Road, Saint Charles, MO 63303 | 2015-02-05 |
| 1164838132 | Francelle Denise Neal | Counselor | 2480 Executive Dr Ste 111, Saint Charles, MO 63303 | 2014-07-10 |
| Find all providers in zip 63303 | ||||
| Taxonomy Code | 213E00000X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457431942 | St Charles Foot Care Center, Terry L. Gamache, Dpm, PC | Podiatrist | 110 S Kingshighway St, Saint Charles, MO 63301-1636 | 2006-10-17 |
| 1174511521 | Daniel Adamovsky | Podiatrist | 2318 Highway 94 South Outer Rd, Saint Charles, MO 63303-8301 | 2005-10-10 |
| 1154319838 | Mark Lewis Rolnick | Podiatrist | 3270 Chester Blvd, Saint Charles, MO 63301-4793 | 2005-10-07 |
| 1487656138 | Terry L Gamache | Podiatrist | 1366 S 5th St, Saint Charles, MO 63301-2444 | 2005-08-12 |
| 1033357314 | Family Foot Care LLC | Podiatrist | 1475 Kisker Rd, Suite 260, Saint Charles, MO 63304 | 2009-01-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902421696 | Kiera Margaret Benge-shea | Podiatrist | 12255 Depaul Drive, Ste 705, Bridgeton, MO 63055 | 2020-06-09 |
| 1972069359 | Dr Jeffrey Brooks PC | Podiatrist | 618 N New Ballas Rd Apt 409, Saint Louis, MO 63141-6767 | 2019-02-11 |
| 1619448453 | S Thomas Sehy D P M L L C | Podiatrist | 6651 Chippewa St Ste 316, Saint Louis, MO 63109-2532 | 2018-12-05 |
| 1902339104 | Jay J Moradia | Podiatrist | 621 S New Ballas Rd Ste 7005b, Saint Louis, MO 63141-8275 | 2017-04-05 |
| 1992185763 | Melanie Gonzalez | Podiatrist | 2406 E R.d. Mize Rd Ste. B, Independence, MO 64057-6405 | 2015-06-05 |
| 1255727525 | Mobile Podiatry of Kansas, LLC | Podiatrist | 1920 Salter Pl, Kirksville, MO 63501-5165 | 2015-04-13 |
| 1346645496 | Ronald Ethan Freilich | Podiatrist | 25107 Cherokee Ln, Jonesburg, MO 63351-2454 | 2014-10-31 |
| 1972922060 | Special Care Podiatry of Missouri, LLC | Podiatrist | 3714 Kidron St, Jackson, MO 63755-3345 | 2014-04-16 |
| 1003152273 | Foot Healers Holdings - St. Louis, LLC | Podiatrist | 8534 Eager Rd, Saint Louis, MO 63144-1435 | 2012-12-17 |
| 1073870234 | Richard Don Bushman | Podiatrist | 603 Claymont Estates Dr, Chesterfield, MO 63017-7061 | 2012-04-12 |
| Find all providers with the same taxonomy | ||||
| City | SAINT CHARLES |
| Zip Code | 63303 |
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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.