NPIMap

Organization Active NPI

St Joseph Primary LLC

  • Family Medicine Physician
  • Kokomo, IN
National Provider Identifier
1104866136
Registry record updated Oct 23, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ST JOSEPH PRIMARY LLC
Practice address
3109 W Sycamore St
Kokomo, IN 46901-4026
Phone
(765) 457-8381
Fax
(765) 457-4443
NPI assigned
Jun 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 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 Manager
Phone
(765) 457-8381

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X IN Primary

Addresses

Primary practice location

3109 W Sycamore St
Kokomo, IN 46901-4026

Mailing address

3109 W Sycamore St
Kokomo, IN 46901-4026
Phone (765) 457-8381

Other identifiers 1

IdentifierTypeStateIssuer
000000183506OtherINBLUE CROSS BLUE SHIELD

Other names 1

  • Sycamore Primary Care 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": "1149638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193097600000",
    "number": "1104866136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3109 W SYCAMORE ST",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469014026",
            "telephone_number": "765-457-8381",
            "fax_number": "765-457-4443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3109 W SYCAMORE ST",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469014026",
            "telephone_number": "765-457-8381",
            "fax_number": "765-457-4443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JOSEPH PRIMARY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-07",
        "last_updated": "2007-10-23",
        "status": "A",
        "authorized_official_last_name": "KELLAR",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "REGIONAL PRACTICE MANAGER",
        "authorized_official_telephone_number": "765-457-8381"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "000000183506",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sycamore Primary Care",
            "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 Oct 23, 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.