NPIMap

Organization Active NPI

Midwest Emergency Associates de Paul LLC

  • Emergency Medicine Physician
  • Bridgeton, MO
National Provider Identifier
1265479448
Registry record updated Feb 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
MIDWEST EMERGENCY ASSOCIATES DE PAUL LLC
Practice address
12303 Depaul Dr
Bridgeton, MO 63044
Phone
(314) 344-6000
Fax
(630) 734-1560
NPI assigned
May 31, 2006
Last updated
Feb 8, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2008

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

Authorized official

Name
Daniel Sullivan, MD
Title
President
Phone
(630) 734-0200

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X NU Primary
Internal Medicine Physician 207R00000X NU

Addresses

Primary practice location

12303 Depaul Dr
Bridgeton, MO 63044

Mailing address

PO Box 5990
Dept 20 6006
Carol Stream, IL 60197-5990
Phone (630) 734-0200

Other identifiers 1

IdentifierTypeStateIssuer
506085505MedicaidMO

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202428800000",
    "number": "1265479448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5990",
            "address_2": "DEPT 20 6006",
            "city": "CAROL STREAM",
            "state": "IL",
            "postal_code": "601975990",
            "telephone_number": "630-734-0200",
            "fax_number": "630-734-1560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12303 DEPAUL DR",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "63044",
            "telephone_number": "314-344-6000",
            "fax_number": "630-734-1560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST EMERGENCY ASSOCIATES DE PAUL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-31",
        "last_updated": "2008-02-08",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-734-0200",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "506085505",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Feb 8, 2008; 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.