NPIMap

Organization Active NPI

Independence Center

Doing business as Independence Center Health Group

  • Community/Behavioral Health Agency
  • Saint Louis, MO
National Provider Identifier
1174668289
Registry record updated Mar 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
INDEPENDENCE CENTER
Doing business as
Independence Center Health Group
Practice address
4245 Forest Park Ave
Saint Louis, MO 63108-2810
Phone
(314) 286-4545
Fax
(314) 286-4542
NPI assigned
Feb 20, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2026

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X
Occupational TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225X00000X
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

4245 Forest Park Ave
Saint Louis, MO 63108-2810

Mailing address

4245 Forest Park Ave
Saint Louis, MO 63108-2810
Phone (314) 880-5401

Other identifiers 2

IdentifierTypeStateIssuer
503350506MedicaidMO
560003943MedicaidMO

Other names 2

  • Independence Center Health Group Doing business as
  • Independence Center Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051111000129 MO Part B Supplier - Clinic/Group Practice 1759341852 Receives reassigned benefits from 11 practitioners
Practice locations: Saint Louis, MO

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

4219 Laclede Ave
Saint Louis, MO 63108
Phone 314533079926

4219 Laclede Ave
Ste B
Saint Louis, MO 63108
Phone (314) 286-4545

4219 Laclede Ave
Rear
Saint Louis, MO 63108
Phone (314) 533-4163

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773792000000",
    "number": "1174668289",
    "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": "314-880-5401",
            "fax_number": "314-880-5468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4245 FOREST PARK AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631082810",
            "telephone_number": "314-286-4545",
            "fax_number": "314-286-4542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENCE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2026-03-18",
        "certification_date": "2026-03-18",
        "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": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "503350506",
            "state": "MO"
        },
        {
            "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": "Independence Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 Mar 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.