ST JOSEPH PRIMARY LLC (NPI# 1982650164) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982650164 |
| Entity Type | Organization |
| Organization Name | ST JOSEPH PRIMARY LLC |
| Other Organization Name | SYCAMORE PEDIATRICS & ADOLESCENTS |
| Practice Address |
3109 W Sycamore St Kokomo IN 46901-4026 |
| Practice Telephone | 7654578381 |
| Practice Fax Number | 7654574443 |
| Mailing Telephone | 7654578381 |
| Mailing Fax Number | 7654574443 |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2007-11-16 |
| Authorized Official Name | ANDREW KELLAR (REGIONAL PRACTICE ADMINISTRATOR) |
| Authorized Official Telephone | 7654578381 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | BLUE CROSS BLUE SHIELD | 000000183506 | 01 |
| Other Name | Type Code |
|---|---|
| Sycamore Pediatrics & Adolescents | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265489975 | St Joseph Primary LLC | Internal Medicine | 615 Saint Joseph Dr, Kokomo, IN 46901-1890 | 2006-05-28 |
| 1073569364 | St Joseph Primary LLC | Family Medicine | 5111 Clinton Dr, Kokomo, IN 46902-7136 | 2006-05-26 |
| 1104866136 | St Joseph Primary LLC | Family Medicine | 3109 W Sycamore St, Kokomo, IN 46901-4026 | 2006-06-07 |
| 1477590164 | St Joseph Primary LLC | Family Medicine | 188 E Southway Blvd, Kokomo, IN 46902-3650 | 2006-06-01 |
| 1780631812 | St Joseph Primary LLC | Legal Medicine | 712 W Main St, Greentown, IN 46936-1045 | 2006-05-27 |
| Street Address |
3109 W SYCAMORE ST |
| City | KOKOMO |
| State | IN |
| Zip Code | 46901-4026 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427040096 | Gregory A Miller | Pharmacist | 3109 W Sycamore St, Kokomo, IN 46901-4026 | 2005-08-18 |
| 1982736377 | St. Joseph Primary Care, LLC | Internal Medicine | 3109 W Sycamore St, Kokomo, IN 46901-4181 | 2007-03-12 |
| 1316006323 | Michelle Ann Shepherd | Pharmacist | 3109 W Sycamore St, Kokomo, IN 46901-4181 | 2006-12-06 |
| 1437231016 | Heidi Renee Vint | Pharmacist | 3109 W Sycamore St, Kokomo, IN 46901-4181 | 2006-10-20 |
| 1720176803 | St. Joseph Primary Care LLC | Clinic/Center | 3109 W Sycamore St, Kokomo, IN 46901-4181 | 2006-10-11 |
| 1104866136 | St Joseph Primary LLC | Family Medicine | 3109 W Sycamore St, Kokomo, IN 46901-4026 | 2006-06-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922607597 | Momentum Kokomo, LLC | Substance Abuse Rehabilitation Facility | 1236 N. Wabash Ave, Kokomo, IN 46901 | 2020-10-23 |
| 1457826869 | Jodi Gayle Lake | Developmental Therapist | 2523 Lorentson Ct, Kokomo, IN 46901 | 2018-10-11 |
| 1871088369 | Hope Behavioral Servies, LLC | Behavioral Analyst | 924 Clark St, Kokomo, IN 46901 | 2018-06-27 |
| 1255782306 | Forefront Dermatology, S.c. | Dermatology | 2130 W Sycamore St Ste 200, Kokomo, IN 46901 | 2016-06-29 |
| 1164860706 | Renee Michelle Brown | Registered Nurse | 2776 Amberwood Place, Kokomo, IN 46901 | 2013-06-05 |
| 1063642916 | Michelle K Rush | Speech-Language Pathologist | 2532 Lauren Ln, Kokomo, IN 46901 | 2009-07-24 |
| 1396957189 | Lifetime Dental Care of In, PC | Dentist | 927 S Washington St, Kokomo, IN 46901 | 2007-05-04 |
| 1245458355 | Wagoner Medical Center, LLC | Internal Medicine | 2016 W Sycamore, Kokomo, IN 46901 | 2007-04-23 |
| 1053442723 | Jesusa Salhieh | Contractor | Genesis Rehab Bloom, Kokomo, IN 46901 | 2007-03-07 |
| 1740382928 | Donald A Fantuzzo Dds PC | Dentist | 2196 W Sycamore St, Kokomo, IN 46901 | 2006-09-01 |
| Find all providers in zip 46901 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891983243 | Olatubosun Olasupo Oguntoye | Pediatrics | 419 E Lincoln Rd, Kokomo, IN 46902-3716 | 2007-10-11 |
| 1700871720 | Eric O'banion | Pediatrics | 3506 S Lafountain St, Kokomo, IN 46902-3803 | 2005-09-15 |
| 1871137786 | Anna Marlene Schultheis | Pediatrics | 419 E Lincoln Rd, Kokomo, IN 46902-3716 | 2019-11-04 |
| 1164859880 | Joint Heirs Pediatrics LLC | Pediatrics | 419 E Lincoln Rd, Kokomo, IN 46902-3716 | 2013-09-27 |
| 1275876310 | Jared A Miller | Pediatrics | 2130 W Sycamore St Ste 260, Kokomo, IN 46901-6460 | 2013-03-27 |
| 1700136769 | Monika Bhagat | Pediatrics | 3118 S Lafountain St, Kokomo, IN 46902-3710 | 2012-09-17 |
| 1063778777 | Laura Elizabeth Stage | Pediatrics | 3506 S Lafountain St, Kokomo, IN 46902-3803 | 2012-04-06 |
| 1245519453 | Rajeswari Cheerath | Pediatrics | 3506 S Lafountain St, Kokomo, IN 46902 | 2011-08-05 |
| 1063731156 | Samatha Madhavarapu | Pediatrics | 3118 S Lafountain St, Kokomo, IN 46902-3710 | 2010-05-27 |
| 1942220785 | Board of Trustees of Howard Community Hospital | Pediatrics | 3506 S Lafountain St, Kokomo, IN 46902-3803 | 2006-07-21 |
| Find all providers in KOKOMO | ||||
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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.