NPIMap

Organization Active NPI

SSM Medical Group Inc.

Doing business as SSM Health Medical Group

  • Durable Medical Equipment & Medical Supplies
  • Bridgeton, MO
National Provider Identifier
1053616110
Registry record updated Aug 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
SSM MEDICAL GROUP INC.
Doing business as
SSM Health Medical Group
Practice address
12349 De Paul Dr
Suite 100
Bridgeton, MO 63044
Phone
(314) 291-3399
Fax
(314) 291-3466
NPI assigned
Jan 21, 2011
Last updated
Aug 18, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
SSM MEDICAL GROUP INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 18, 2020

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

Authorized official

Name
Karen Rewerts
Title
VP Financial Operations
Phone
(314) 989-2034

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU Primary
Orthopaedic Surgery Physician 207X00000X MO

Addresses

Primary practice location

12349 De Paul Dr
Suite 100
Bridgeton, MO 63044

Mailing address

3221 McKelvey Rd Ste 301
Bridgeton, MO 63044-2551
Phone (636) 498-5944

Other names 1

  • SSM Health Medical Group Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180922000044 MO DME Supplier - Physician - General Surgery 6608776299 Practice locations: Bridgeton, MO

Other NPIs with the same Medicare PAC ID 7

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

National Provider Directory

National Provider Directory
Tax ID family
SSM Medical Group Inc18 organizations share this tax ID, including this one
Part of
SSM Medical Group Inc

Other organizations with this tax ID 17

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

View all 17

Locations

12349 De Paul Dr
Ste 100
Bridgeton, MO 63044
Phone (314) 291-3399

NPI Registry JSON

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

{
    "created_epoch": "1295568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597708800000",
    "number": "1053616110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3221 MCKELVEY RD STE 301",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442551",
            "telephone_number": "636-498-5944",
            "fax_number": "314-209-8127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12349 DE PAUL DR",
            "address_2": "SUITE 100",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "63044",
            "telephone_number": "314-291-3399",
            "fax_number": "314-291-3466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SSM MEDICAL GROUP INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SSM MEDICAL GROUP INC.",
        "enumeration_date": "2011-01-21",
        "last_updated": "2020-08-18",
        "certification_date": "2020-08-18",
        "status": "A",
        "authorized_official_last_name": "REWERTS",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "VP FINANCIAL OPERATIONS",
        "authorized_official_telephone_number": "314-989-2034"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MO",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SSM Health Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SSM Health Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bridgeton, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2020; 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.

Verify at the official NPI Registry.