NPIMap

Organization Active NPI

St Joseph Primary LLC

Doing business as Med One Of St Joseph

  • Urgent Care Clinic/Center
  • Kokomo, IN
National Provider Identifier
1073569364
Registry record updated Nov 16, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
ST JOSEPH PRIMARY LLC
Doing business as
Med One Of St Joseph
Practice address
5111 Clinton Dr
Kokomo, IN 46902-7136
Phone
(765) 453-8800
Fax
(765) 457-4443
NPI assigned
May 26, 2006
Last updated
Nov 16, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2007

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

Authorized official

Name
Andrew Kellar
Title
Regional Practice Administrator
Phone
(765) 457-8381

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X IN Primary
Family Medicine Physician 207Q00000X IN

Addresses

Primary practice location

5111 Clinton Dr
Kokomo, IN 46902-7136

Mailing address

5111 Clinton Dr
Kokomo, IN 46902-7136
Phone (765) 453-8800

Other identifiers 2

IdentifierTypeStateIssuer
20031200MedicaidIN
000000183506OtherINBLUE CROSS BLUE SHIELD

Other names 1

  • Med One Of St Joseph Doing business as

National Provider Directory

National Provider Directory
Tax ID family
St Joseph Primary LLC13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

NPI Registry JSON

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195171200000",
    "number": "1073569364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5111 CLINTON DR",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469027136",
            "telephone_number": "765-453-8800",
            "fax_number": "765-457-4443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5111 CLINTON DR",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469027136",
            "telephone_number": "765-453-8800",
            "fax_number": "765-457-4443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JOSEPH PRIMARY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-26",
        "last_updated": "2007-11-16",
        "status": "A",
        "authorized_official_last_name": "KELLAR",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "REGIONAL PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "765-457-8381"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "IN",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20031200",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "000000183506",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Med One Of St Joseph",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kokomo, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2007; 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.