NPIMap

Organization Active NPI

SSM Depaul Medical Group, Inc.

Doing business as DePaul Medical Group Neurosurgery

  • Neurological Surgery Physician
  • Bridgeton, MO
National Provider Identifier
1154434736
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
Legal business name
SSM DEPAUL MEDICAL GROUP, INC.
Doing business as
DePaul Medical Group Neurosurgery
Practice address
12255 De Paul Dr
Suite 830
Bridgeton, MO 63044-2510
Phone
(314) 291-6556
NPI assigned
Aug 16, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ms. Laura Pullum
Title
Director of Patient Accounts
Phone
(314) 209-8121

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207T00000X Primary

Addresses

Primary practice location

12255 De Paul Dr
Suite 830
Bridgeton, MO 63044-2510

Mailing address

12255 De Paul Dr
Suite 830
Bridgeton, MO 63044-2510
Phone (314) 291-6556

Other names 1

  • DePaul Medical Group Neurosurgery Doing business as

National Provider Directory

National Provider Directory
Tax ID family
SSM Depaul Medical Group13 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.

Locations

12255 De Paul Dr
Ste 830
Bridgeton, MO 63044
Phone (314) 291-6556

NPI Registry JSON

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1154434736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12255 DE PAUL DR",
            "address_2": "SUITE 830",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442510",
            "telephone_number": "314-291-6556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12255 DE PAUL DR",
            "address_2": "SUITE 830",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442510",
            "telephone_number": "314-291-6556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SSM DEPAUL MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PULLUM",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "DIRECTOR OF PATIENT ACCOUNTS",
        "authorized_official_telephone_number": "314-209-8121",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Neurological Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DePaul Medical Group Neurosurgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bridgeton, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.