NPIMap

Organization Active NPI

SSM Medical Group, Inc.

Doing business as SSM Health Medical Group

  • Durable Medical Equipment & Medical Supplies
  • Florissant, MO
National Provider Identifier
1194736116
Registry record updated Aug 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
SSM MEDICAL GROUP, INC.
Doing business as
SSM Health Medical Group
Practice address
1120 Shackelford Rd
Florissant, MO 63031
Phone
(314) 921-4420
Fax
(314) 921-6086
NPI assigned
Aug 11, 2006
Last updated
Aug 18, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2020

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

Authorized official

Name
Karen Rewerts
Title
VP Financial Operations
Phone
(314) 989-2034

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU Primary
Internal Medicine Physician 207R00000X NU
Rheumatology Physician 207RR0500X NU

Addresses

Primary practice location

1120 Shackelford Rd
Florissant, MO 63031

Mailing address

PO Box 955534
Saint Louis, MO 63195-5534

Other names 1

  • SSM Health Medical Group Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180922000132 MO DME Supplier - Physician - General Surgery 6608776299 Practice locations: Florissant, MO

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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
26D1106226SSM Medical Group North County1120 Shackelford Road, Florissant, MO 63031Provider-performed microscopyOct 6, 2027

National Provider Directory

National Provider Directory
Tax ID family
SSM Medical Group Inc18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

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

View all 17

Locations

1120 Shackelford Rd
Florissant, MO 63031
Phone (314) 830-5805

NPI Registry JSON

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597708800000",
    "number": "1194736116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 955534",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631955534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 SHACKELFORD RD",
            "city": "FLORISSANT",
            "state": "MO",
            "postal_code": "63031",
            "telephone_number": "314-921-4420",
            "fax_number": "314-921-6086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SSM MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-11",
        "last_updated": "2020-08-18",
        "certification_date": "2020-08-18",
        "status": "A",
        "authorized_official_last_name": "REWERTS",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "VP FINANCIAL OPERATIONS",
        "authorized_official_telephone_number": "314-989-2034"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SSM Health Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Florissant, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2020; 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.