NPIMap

Organization Active NPI

Saint Medical Group, LLC

Doing business as SSM Health Medical Group Seminole Specialty Care

  • Interventional Cardiology Physician
  • Seminole, OK
National Provider Identifier
1073108460
Registry record updated Mar 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
Legal business name
SAINT MEDICAL GROUP, LLC
Doing business as
SSM Health Medical Group Seminole Specialty Care
Practice address
2403 W Wrangler Blvd
Seminole, OK 74868-1900
Phone
(405) 732-7020
Fax
(405) 732-7839
NPI assigned
Mar 8, 2021
Last updated
Mar 8, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
SSM HEALTH CARE OF OKLAHOMA, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 8, 2021

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

Authorized official

Name
Crystal L Pena
Title
Credentialing Specialist
Phone
(405) 272-7452

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Cardiology Physician 207RI0011X NU Primary
Urology Physician 208800000X NU

Addresses

Primary practice location

2403 W Wrangler Blvd
Seminole, OK 74868-1900

Mailing address

2403 W Wrangler Blvd
Seminole, OK 74868-1900
Phone (405) 732-7020

Other names 1

  • SSM Health Medical Group Seminole Specialty Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Saints Medical Group LLC114 organizations share this tax ID, including this one
Part of
St Anthony Hospital Esr

Organizations with this tax ID in the same state 20

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 20

Locations

2403 W Wrangler Blvd
Seminole, OK 74868
Phone (405) 382-4939

NPI Registry JSON

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

{
    "created_epoch": "1615161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615161600000",
    "number": "1073108460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2403 W WRANGLER BLVD",
            "city": "SEMINOLE",
            "state": "OK",
            "postal_code": "748681900",
            "telephone_number": "405-732-7020",
            "fax_number": "405-732-7839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2403 W WRANGLER BLVD",
            "city": "SEMINOLE",
            "state": "OK",
            "postal_code": "748681900",
            "telephone_number": "405-732-7020",
            "fax_number": "405-732-7839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAINT MEDICAL GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SSM HEALTH CARE OF OKLAHOMA, INC.",
        "enumeration_date": "2021-03-08",
        "last_updated": "2021-03-08",
        "certification_date": "2021-03-08",
        "status": "A",
        "authorized_official_last_name": "PENA",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "405-272-7452"
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SSM Health Medical Group Seminole Specialty Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Seminole, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2021; 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.