Active NPI
SSM Health Care St Louis
- Community/Retail Pharmacy
- Saint Louis, MO
National Provider Identifier
1013096510
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 005355
- Legal business name
- SSM HEALTH CARE ST LOUIS
- Practice address
- 1035 Bellevue Ave
Saint Louis, MO 63117-1854 - Phone
- (314) 768-8870
- NPI assigned
- Nov 3, 2006
- Organization subpart
- Yes
- Parent organization
- SSM HEALTHCARE ST. LOUIS
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Kimberly Spencer
- Title
- V.P. Pharmacy Services
- Phone
- (314) 989-2588
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 005355 | MO | Primary |
Addresses
Primary practice location
1035 Bellevue Ave
Saint Louis, MO 63117-1854
Mailing address
10101 Woodfield LN
Saint Louis, MO 63132-2946
Phone (314) 994-7800
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2627620 | Other | NCPDP NUMBER | |
| 5355 | Other | MO | STATE LICENSE |
| 602252611 | Medicaid | MO |
Other names 1
- SSM Health Pharmacy
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230509001911 | MO | Part B Supplier - Pharmacy | 7810800737 |
4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Wentzville, MO; Saint Louis, MO; Saint Charles, MO; Bridgeton, MO |
Other NPIs on the same Medicare enrollment 4
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider Directory- Part of
- Good Samaritan RHC Wayn
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162512000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1666051200000",
"number": "1013096510",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10101 WOODFIELD LN",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631322946",
"telephone_number": "314-994-7800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1035 BELLEVUE AVE",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631171854",
"telephone_number": "314-768-8870"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SSM HEALTH CARE ST LOUIS",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "SSM HEALTHCARE ST. LOUIS",
"enumeration_date": "2006-11-03",
"last_updated": "2022-10-18",
"certification_date": "2022-10-18",
"status": "A",
"authorized_official_last_name": "SPENCER",
"authorized_official_first_name": "KIMBERLY",
"authorized_official_title_or_position": "V.P. PHARMACY SERVICES",
"authorized_official_telephone_number": "314-989-2588"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "MO",
"license": "005355",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCPDP NUMBER",
"identifier": "2627620",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "5355",
"state": "MO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "602252611",
"state": "MO"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "SSM Health Pharmacy",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.