NPIMap

Organization Active NPI

SSM Health Care St. Louis

Doing business as SSM Health DePaul Hospital - St. Louis

  • Psychiatric Hospital Unit
  • Bridgeton, MO
National Provider Identifier
1053481861
Registry record updated Aug 31, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
License
414-11 Issued in MO
Legal business name
SSM HEALTH CARE ST. LOUIS
Doing business as
SSM Health DePaul Hospital - St. Louis
Practice address
12303 De Paul Dr
Bridgeton, MO 63044-2512
Phone
(314) 344-6000
NPI assigned
Nov 9, 2006
Last updated
Aug 31, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
SSM HEALTH CARE CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 31, 2021

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

Authorized official

Name
Ms. Tina Garrison
Title
President
Phone
(314) 344-7210

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X 414-11 MO Primary

Addresses

Primary practice location

12303 De Paul Dr
Bridgeton, MO 63044-2512

Mailing address

12303 De Paul Dr
Bridgeton, MO 63044-2512
Phone (314) 344-6000

Other identifiers 4

IdentifierTypeStateIssuer
010494102MedicaidMO
431704972001MedicaidIL
431704972401MedicaidIL
540494101MedicaidMO

Other names 1

  • SSM Health DePaul Hospital - St. Louis Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160223001141 MO Part A Provider - Hospital 7810800737 Practice locations: Bridgeton, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053481861. Details of each certification follow.

Hospital certification: CCN 26S104

Legal name
SSM HEALTH CARE ST LOUIS
Doing business as
SSM HEALTH DEPAUL HOSPITAL ST LOUIS
Organization structure
CorporationNon-profit
Incorporated
Sep 11, 1984 in MO
Enrollment address
12303 De Paul Dr
Bridgeton, MO 63044-2512
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 13

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 13

National Provider Directory

National Provider Directory
Tax ID family
William D Huffstutler M15 organizations share this tax ID, including this one
Part of
SSM Health Care Corporation

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 19

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Sriram Vissa Individual Corporate OfficerInterim President Jun 1, 2023
Kevin Smith Individual Corporate OfficerTreasurer Oct 1, 2023
Christine K Jacobs Individual Corporate Director Dec 20, 2021
Snehal R Gandhi Individual Corporate DirectorBoard Member Aug 1, 2017
Kevin Elledge Individual Corporate DirectorBoard Member Apr 2, 2021
Douglass Petty Individual Corporate DirectorBoard Member Jun 1, 2019
Jeremy M Fotheringham Individual Corporate OfficerRegional President, SSM Health Apr 2, 2021
Corporate DirectorBoard Member Apr 2, 2021
Timothy Allen Johnson Individual Corporate Director Dec 17, 2021
Douglas P Long Individual Corporate OfficerSecretary Jun 1, 2019
SSM Health Care Corporation Organization, Saint Louis, MO Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Sep 1, 2015 85%
Dennis Harms Individual Corporate DirectorBoard Member Jun 1, 2019
Eileen Lamm Individual Corporate OfficerRegional Vice President Finance Mar 23, 2020
Operational/Managerial ControlRegional Vice President Finance Mar 23, 2020
SSM Health Care St Louis Organization, Saint Louis, MO Corporation, Non-profit 5% Or Greater Direct Ownership Interest Dec 16, 2013 100%
St Louis University Organization, Saint Louis, MO Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Sep 1, 2015 15%
Timothy Buller Individual Corporate OfficerRegional Cfo Financial Strategy Sep 1, 2015
Operational/Managerial ControlRegional Cfo Financial Strategy Oct 9, 2013
Joseph Yancey Individual Corporate DirectorBoard Member Apr 2, 2021
Laura Kaiser Individual Corporate OfficerPresident, Ceo, SSM Health May 1, 2017
Steven Smoot Individual Corporate OfficerVice President Jan 1, 2020
Corporate DirectorBoard Member Aug 8, 2018
Jan Cerny Individual Corporate OfficerVice Chairperson Apr 2, 2021
Corporate DirectorBoard Member Sep 1, 2015

Owners & managing parties with NPI records 15

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 15

All facility ownership & control disclosures 10

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
SSM Health St. Clare Hospital - FentonFenton, MO, CCN 260081 Hospital 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2015
SSM Health Rehabilitation HospitalRichmond Heights, MO, CCN 263031 Hospital 5% Or Greater Direct Ownership Interest (49%) May 1, 2009
SSM Health Saint Louis University HospitalSaint Louis, MO, CCN 260105 Hospital 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2015
SSM Health Saint Louis University HospitalSaint Louis, MO, CCN 26S105 Hospital 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2015
SSM Health St Joseph Hospital - Lake Saint LouisLake Saint Louis, MO, CCN 260200 Hospital 5% Or Greater Direct Ownership Interest (100%) Sep 17, 2014
SSM Health St Joseph Hospital - St CharlesSaint Charles, MO, CCN 260005 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Sep 11, 1984
Oct 12, 2015
SSM Health St. Mary's Hospital - St. LouisSaint Louis, MO, CCN 26S091 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 13, 2014
SSM Health St. Mary's Hospital - St LouisSaint Louis, MO, CCN 260091 Hospital 5% Or Greater Direct Ownership Interest (100%) Sep 11, 1984
SSM Health Depaul Hospital - St LouisBridgeton, MO, CCN 260104 Hospital 5% Or Greater Direct Ownership Interest (100%) Oct 10, 2014
SSM Health Depaul Hospital - Anna HouseBridgeton, MO, CCN 265842 Skilled nursing facility 5% Or Greater Indirect Ownership Interest (100%) Sep 1, 2015

Owned or controlled facilities with NPI records 11

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • SSM Health Care St. Louis

    dba SSM Health Cardinal Glennon Children's Hospital

    • General Acute Care Hospital
    • Saint Louis, MO
    • NPI 1336387836

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • SSM Health Care St. Louis

    dba SSM Health DePaul Hospital - Anna House

    • Skilled Nursing Facility
    • Bridgeton, MO
    • NPI 1346237112

    5% Or Greater Indirect Ownership Interest

    CMS ownership
  • SSM Health Care St. Louis

    dba SSM Health St. Joseph Hospital - St. Charles

    • General Acute Care Hospital
    • Saint Charles, MO
    • NPI 1467521146

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • SSM Health Care St. Louis

    dba SSM Health DePaul Hospital - St. Louis

    • General Acute Care Hospital
    • Bridgeton, MO
    • NPI 1598835308

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • SSM Health Care St. Louis

    dba SSM Health St. Mary's Hospital - St. Louis

    • Psychiatric Hospital Unit
    • Saint Louis, MO
    • NPI 1780763284

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • SSM Health Care St. Louis

    dba SSM Health St. Clare Hospital - Fenton

    • General Acute Care Hospital
    • Fenton, MO
    • NPI 1851496152

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • SSM Health Care St. Louis

    dba SSM Health St Joseph Hospital - Lake Saint Louis

    • General Acute Care Hospital
    • Lake St Louis, MO
    • NPI 1871665380

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • SSM Health Care St. Louis

    dba SSM Health St. Mary's Hospital - St. Louis

    • General Acute Care Hospital
    • Saint Louis, MO
    • NPI 1962572396

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • SSM Select Rehab St Louis LLC
    • Rehabilitation Hospital
    • Richmond Heights, MO
    • NPI 1659511988

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • SSM-Sluh Inc

    dba SSM Health Saint Louis University Hospital

    • Psychiatric Hospital Unit
    • Saint Louis, MO
    • NPI 1528443702

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • SSM-Sluh Inc

    dba SSM Health Saint Louis University Hospital

    • General Acute Care Hospital
    • Saint Louis, MO
    • NPI 1942685920

    5% Or Greater Direct Ownership Interest

    CMS ownership

Facilities with the same owner 31

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 31

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630368000000",
    "number": "1053481861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12303 DE PAUL DR",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442512",
            "telephone_number": "314-344-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12303 DE PAUL DR",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442512",
            "telephone_number": "314-344-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SSM HEALTH CARE ST. LOUIS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SSM HEALTH CARE  CORPORATION",
        "enumeration_date": "2006-11-09",
        "last_updated": "2021-08-31",
        "certification_date": "2021-08-31",
        "status": "A",
        "authorized_official_last_name": "GARRISON",
        "authorized_official_first_name": "TINA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "314-344-7210",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "MO",
            "license": "414-11",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010494102",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "431704972001",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "431704972401",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "540494101",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "SSM Health DePaul Hospital - St. Louis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SSM Health DePaul Hospital - St. Louis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bridgeton, MO

Sources for this page

Verify at the official NPI Registry.