NPIMap

Organization Active NPI

Independence Center

  • Psychiatry Physician
  • Saint Louis, MO
National Provider Identifier
1083054787
Registry record updated Jun 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
INDEPENDENCE CENTER
Doing business as
Independence Center Health Group
Midwest Psychiatry
Practice address
4219 Laclede Ave
Saint Louis, MO 63108-2814
Phone
(314) 880-5415
Fax
(314) 880-5468
NPI assigned
Jun 27, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2022

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

Authorized official

Name
Mrs. Patricia Holmes
Title
Executive Director
Phone
(314) 880-5415

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X MO Primary

Addresses

Primary practice location

4219 Laclede Ave
Saint Louis, MO 63108-2814

Mailing address

4245 Forest Park Ave
Saint Louis, MO 63108-2810
Phone (314) 880-5415

Other identifiers 1

IdentifierTypeStateIssuer
560003943MedicaidMO

Other names 2

  • Independence Center Health Group Doing business as
  • Midwest Psychiatry Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Independence Center6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

4245 Forest Park Ave
Saint Louis, MO 63108
Phone (314) 286-4545

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/independencecenter/r4/

NPI Registry JSON

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

{
    "created_epoch": "1372291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656288000000",
    "number": "1083054787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4245 FOREST PARK AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631082810",
            "telephone_number": "314-880-5415",
            "fax_number": "314-880-5468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4219 LACLEDE AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631082814",
            "telephone_number": "314-880-5415",
            "fax_number": "314-880-5468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENCE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-27",
        "last_updated": "2022-06-27",
        "certification_date": "2022-06-27",
        "status": "A",
        "authorized_official_last_name": "HOLMES",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "314-880-5415",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "560003943",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Independence Center Health Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Midwest Psychiatry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2022; 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.