SSM Medical Group

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

SSM MEDICAL GROUP

Doing business as

Suburban West Internal Medicine

Practice address

1011 Bowles Ave
Suite 300
Fenton, MO 63026-2387

Phone

(636) 496-5000

Fax

(636) 496-5045

NPI assigned

Jul 20, 2007

Last updated

Jul 8, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. James E Bieser

Title

Executive Director

Phone

(314) 822-5900

Specialties & licenses 1

Addresses

Other names 1

• Suburban West Internal Medicine Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1247011200000",
    "number": "1023218898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 BOWLES AVE",
            "address_2": "SUITE 300",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630262387",
            "telephone_number": "636-496-5000",
            "fax_number": "636-496-5045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 BOWLES AVE",
            "address_2": "SUITE 300",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630262387",
            "telephone_number": "636-496-5000",
            "fax_number": "636-496-5045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SSM MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-20",
        "last_updated": "2009-07-08",
        "status": "A",
        "authorized_official_last_name": "BIESER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "314-822-5900",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Suburban West Internal Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Internal Medicine Physician in Fenton, MO
• Providers in Fenton, MO by specialty
• Internal Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.