SSM HEALTH CARE ST LOUIS (NPI# 1275586174) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275586174 |
| Entity Type | Organization |
| Organization Name | SSM HEALTH CARE ST LOUIS |
| Other Organization Name | SSM HEALTH ST. CLARE HOSPITAL PHYSICIAN BILLING |
| Practice Address |
1015 Bowles Avenue Fenton MO 63026 |
| Mailing Address |
1145 Corporate Lake Dr Saint Louis MO 63132-2907 |
| Practice Telephone | 6364962502 |
| Mailing Telephone | 3149896843 |
| Mailing Fax Number | 3143447281 |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2019-03-12 |
| Authorized Official Name | MS. SHARON R. DUDLEY (EVP/COO) |
| Authorized Official Telephone | 3147688032 |
| Is Organization Subpart | Y |
| Parent Organization Name | SSM HEALTH CARE ST. LOUIS |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2086S0129X |
Surgery Specialization: Vascular Surgery |
Allopathic & Osteopathic Physicians | ||
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians | ||
| Y | 207P00000X | Emergency Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 545011009 | 05 |
| Other Name | Type Code |
|---|---|
| SSM Health St Clare Hospital | Doing Business As Name - Organization |
| SSM Health St. Clare Hospital Physician Billing | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1296 Jeffco Blvd Ste B, Arnold, MO 630102138 | 6363218604 | 3143447281 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154728640 | Ssm Health Care St Louis | Pharmacy | 500 Medical Dr, Wentzville, MO 63385-3421 | 2014-11-26 |
| Street Address |
1015 BOWLES AVENUE |
| City | FENTON |
| State | MO |
| Zip Code | 63026 |
| 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 | 207P00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: mofified source] - Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326085457 | James R Taylor | Emergency Medicine | 1015 Bowles Ave., Fenton, MO 63026 | 2006-05-31 |
| 1982687059 | Robert Brunton Smith | Emergency Medicine | 1015 Bowles Ave, Fenton, MO 63026-2394 | 2005-11-22 |
| 1093360414 | Cep America LLC | Emergency Medicine | 1015 Bowles Ave, Fenton, MO 63026-2394 | 2019-08-02 |
| 1437681418 | Matthew Schwab | Emergency Medicine | 1015 Bowles Ave, Fenton, MO 63026-2394 | 2017-03-30 |
| 1558502989 | Midwest Emergency Associates-fenton, LLC | Emergency Medicine | 1015 Bowles Ave, Fenton, MO 63026-2394 | 2009-03-16 |
| 1164614798 | Mclaren Medical Group | Emergency Medicine | 2420 Owen Rd, Fenton, MI 48430-3417 | 2007-08-17 |
| 1376746800 | Stephen Slowik | Emergency Medicine | 1015 Bowles Ave, Fenton, MO 63026-2394 | 2007-06-11 |
| 1275643553 | Patricia A. Williams | Emergency Medicine | 1203 Smizer Mill Rd, Suite 100, Fenton, MO 63026-3483 | 2006-08-30 |
| 1730108101 | Tuere A Franklin | Emergency Medicine | 1015 Bowles Ave, Fenton, MO 63026-2394 | 2006-07-18 |
| 1073538302 | Jeffrey J Hallazgo | Emergency Medicine | 714 Gravois Rd, Suite 100, Fenton, MO 63026-7723 | 2006-07-13 |
| Find all providers in FENTON | ||||
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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.