NPIMap

Organization Active NPI

Christian Hospital Northeast-Northwest

Doing business as Christian Hospital

  • Ambulance
  • Saint Louis, MO
National Provider Identifier
1073769329
Registry record updated Mar 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
AmbulanceTaxonomy code 341600000X
License
425-9 Issued in MO
Legal business name
CHRISTIAN HOSPITAL NORTHEAST-NORTHWEST
Doing business as
Christian Hospital
Practice address
11133 Dunn Rd
Saint Louis, MO 63136-6119
Phone
(314) 653-5000
Fax
(314) 653-4153
NPI assigned
Aug 18, 2008
Last updated
Mar 18, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
CHRISTIAN HOSPITAL NORTHEAST-NORTHWESTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 18, 2021

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

Authorized official

Name
Mrs. Susan C Koesterer
Title
Vice President, Finance
Phone
(314) 653-5715

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulance 341600000X 425-9 MO Primary

Addresses

Primary practice location

11133 Dunn Rd
Saint Louis, MO 63136-6119

Mailing address

11133 Dunn Rd
Saint Louis, MO 63136-6119
Phone (314) 653-5000

Other identifiers 1

IdentifierTypeStateIssuer
800490609MedicaidMO

Other names 1

  • Christian Hospital Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061106000201 MO Part A Provider - Hospital 8921904178 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Florissant, MO; Saint Peters, MO; Saint Louis, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073769329. Details of each certification follow.

Hospital certification: CCN 260180

Legal name
CHRISTIAN HOSPITAL NORTHEAST NORTHWEST
Doing business as
CHRISTIAN HOSPITAL NORTHEAST NORTHWEST
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Sep 28, 1975
Last certification
May 3, 2011
Beds
475
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Enrollment address
11133 Dunn Rd
Saint Louis, MO 63136-6163
Main/Primary Hospital Location
Hospital subgroups
General, Acute care, Other

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

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Christian Hospital NortheastCCN 260180 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Joan H Mass MD7 organizations share this tax ID, including this one
Part of
Joan H Mass MD

Other organizations with this tax ID 6

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

Locations

11133 Dunn Rd
Ste H2241
Saint Louis, MO 63136
Phone (314) 355-2860

Ownership & related parties

All disclosed owners & managing parties 24

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

NameRoleSinceShare
Stanley Williams Individual Corporate Director Jan 1, 2022
Operational/Managerial Control Jan 1, 2022
Erica Henderson Individual Corporate Director Jan 1, 2020
Operational/Managerial Control Jan 1, 2020
Olayiwola C Olagbegi Individual Corporate DirectorChief of Staff Jan 1, 2026
Operational/Managerial ControlChief of Staff Jan 1, 2026
Bradley D Freeman Individual Corporate DirectorChief of Staff Jan 1, 2025
Charlotte Hammond Individual Corporate DirectorBoard Member Jan 1, 2023
Operational/Managerial ControlBoard Member Jan 1, 2023
Rhonda K Hamm-Niebruegge Individual Corporate Officer Jan 1, 2019
Corporate Director Jan 1, 2019
Operational/Managerial Control Jan 1, 2019
Michael Kennedy Individual Corporate Director Jan 1, 2020
Operational/Managerial Control Jan 1, 2020
Pervis Brown Individual Corporate DirectorBoard Member Jan 1, 2026
Ricky Stevens Individual Corporate OfficerPresident Jun 27, 2016
Corporate DirectorPresident Jun 27, 2016
W-2 Managing EmployeePresident Jun 27, 2016
Operational/Managerial ControlPresident Jun 27, 2016
John P Lynch Individual Corporate DirectorBoard Member Jan 1, 2026
John Moten Individual Corporate Director Jan 1, 2023
BJC Health System Organization, Saint Louis, MO Non-profit Other May 11, 1992
Ross Toohey Individual Corporate DirectorBoard Member Jan 1, 2021
Operational/Managerial ControlBoard Member Jan 1, 2021
Moyosore K Onifade Individual Corporate DirectorBoard Member Jan 1, 2026
Matthew Forck Individual Corporate DirectorBoard Member Jan 1, 2021
Operational/Managerial ControlBoard Member Jan 1, 2021
Paul Irovic Individual Corporate OfficerVice President, Finance Feb 1, 2023
Operational/Managerial ControlVice President, Finance Feb 1, 2023
David Otto Individual Corporate DirectorBoard Member Jan 1, 2001
Operational/Managerial ControlBoard Member Jan 1, 2001
Robert W. Cannon Individual Corporate DirectorBoard Member Aug 1, 2020
Operational/Managerial ControlBoard Member Aug 1, 2020
Douglas a Blair Individual Corporate DirectorSecretary Jan 1, 2025
Scott Hawig Individual Corporate OfficerVice President, Finance Jan 1, 2026
Operational/Managerial ControlVice President, Finance Jan 1, 2026
Christian Hospital Northeast Northwest Organization, Saint Louis, MO Non-profit Operational/Managerial Control Jun 1, 1993
Carlton Adams Individual Corporate DirectorBoard Member Jan 1, 2022
Operational/Managerial ControlBoard Member Jan 1, 2022
Christian Health Services Development Corporation Organization, Saint Louis, MO Non-profit Other Mar 16, 1981
Jeff Pittman Individual Corporate DirectorBoard Member Jan 1, 2019
Operational/Managerial ControlBoard Member Jan 1, 2019

Owners & managing parties with NPI records 6

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

Practitioners & affiliated clinicians

Affiliated clinicians 726

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 726

NPI Registry JSON

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

{
    "created_epoch": "1219017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616025600000",
    "number": "1073769329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11133 DUNN RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631366119",
            "telephone_number": "314-653-5000",
            "fax_number": "314-653-4153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11133 DUNN RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631366119",
            "telephone_number": "314-653-5000",
            "fax_number": "314-653-4153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRISTIAN HOSPITAL NORTHEAST-NORTHWEST",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHRISTIAN HOSPITAL NORTHEAST-NORTHWEST",
        "enumeration_date": "2008-08-18",
        "last_updated": "2021-03-18",
        "certification_date": "2021-03-18",
        "status": "A",
        "authorized_official_last_name": "KOESTERER",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "VICE PRESIDENT, FINANCE",
        "authorized_official_telephone_number": "314-653-5715",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "MO",
            "license": "425-9",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "800490609",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "11133 Dunn Rd",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631366119",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Christian Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Christian Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.