NPIMap

Organization Active NPI

Ste. Genevieve County Memorial Hospital

Doing business as Bloomsdale Specialty Clinic

  • Foot Surgery Podiatrist
  • Bloomsdale, MO
National Provider Identifier
1104692946
Registry record updated Sep 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot Surgery PodiatristTaxonomy code 213ES0131X
Legal business name
STE. GENEVIEVE COUNTY MEMORIAL HOSPITAL
Doing business as
Bloomsdale Specialty Clinic
Practice address
255 Boderman Ste 2C
Bloomsdale, MO 63627-9099
Phone
(573) 883-2751
NPI assigned
Dec 4, 2023
Last updated
Sep 11, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
STE GENEVIEVE COUNTY MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 11, 2026

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

Authorized official

Name
Scott Griffin
Title
Revenue Cycle Director
Phone
(573) 883-2751

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot Surgery Podiatrist 213ES0131X NU Primary

Addresses

Primary practice location

255 Boderman Ste 2C
Bloomsdale, MO 63627-9099

Mailing address

800 Ste Genevieve Dr
Ste Genevieve, MO 63670-1434

Other names 1

  • Bloomsdale Specialty Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040102000645 MO Part B Supplier - Clinic/Group Practice 3274432802 Receives reassigned benefits from 66 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bloomsdale, MO; Ste Genevieve, MO

Other NPIs on the same Medicare enrollment 4

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D2052069Bloomsdale Specialty Clinic255 Boderman Lane, Suite 2a, Bloomsdale, MO 63627Certificate of waiverJan 3, 2027

National Provider Directory

National Provider Directory
Tax ID family
St Genevieve Med Hosp17 organizations share this tax ID, including this one
Part of
St Genevieve Med Hosp

Other organizations with this tax ID 16

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

View all 16

Locations

255 Boderman
Ste 2C
Bloomsdale, MO 63627

255 Boderman
Ste C
Bloomsdale, MO 63627
Phone (573) 483-9492

37 Meyer Ln
Bloomsdale, MO 63627
Phone (573) 483-3733

92 Mill Hill Rd
Ste 2
Bloomsdale, MO 63627
Phone (573) 883-7709

930 Park Dr
Ste 2
Ste Genevieve, MO 63670
Phone (573) 883-7424

Practitioners & affiliated clinicians

Practitioners 104

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 104

NPI Registry JSON

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

{
    "created_epoch": "1701648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1789084800000",
    "number": "1104692946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 STE GENEVIEVE DR",
            "city": "STE GENEVIEVE",
            "state": "MO",
            "postal_code": "636701434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 BODERMAN STE 2C",
            "city": "BLOOMSDALE",
            "state": "MO",
            "postal_code": "636279099",
            "telephone_number": "573-883-2751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STE. GENEVIEVE COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STE GENEVIEVE COUNTY MEMORIAL HOSPITAL",
        "enumeration_date": "2023-12-04",
        "last_updated": "2026-09-11",
        "certification_date": "2026-09-11",
        "status": "A",
        "authorized_official_last_name": "GRIFFIN",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "REVENUE CYCLE DIRECTOR",
        "authorized_official_telephone_number": "573-883-2751"
    },
    "taxonomies": [
        {
            "code": "213ES0131X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bloomsdale Specialty Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bloomsdale, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.