SSM St. Charles Clinic Medical Group, Inc.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

SSM ST. CHARLES CLINIC MEDICAL GROUP, INC.

Doing business as

SSM Health Medical Group

Practice address

172 Professional Parkway
Troy, MO 63379-1520

Phone

(636) 462-6106

Fax

(636) 669-2401

NPI assigned

Aug 23, 2006

Last updated

Jan 15, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Laura Pullum

Title

Billing Manager

Phone

(636) 669-2434

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• SSM Health Medical Group Doing business as

Practitioners 3

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.

• Douglas A Barton, M.D.

  • Pediatrics Physician
  • Lake St Louis, MO
  • NPI 1144281890
  NPD (past)
• Rodrigo G Goh, M.D.

  • Cardiovascular Disease Physician
  • Troy, MO
  • NPI 1487615241
  NPD (past)
• Joanne M Wolfe, M.D.

  • Pediatrics Physician
  • Arvada, CO
  • NPI 1851352660
  NPD (past)

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

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452816000000",
    "number": "1285741629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1551 WALL ST",
            "address_2": "SUITE 310",
            "city": "SAINT CHARLES",
            "state": "MO",
            "postal_code": "633033539",
            "telephone_number": "636-669-2268",
            "fax_number": "314-209-8127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "172 PROFESSIONAL PARKWAY",
            "city": "TROY",
            "state": "MO",
            "postal_code": "633791520",
            "telephone_number": "636-462-6106",
            "fax_number": "636-669-2401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SSM ST. CHARLES CLINIC MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-23",
        "last_updated": "2016-01-15",
        "status": "A",
        "authorized_official_last_name": "PULLUM",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "636-669-2434",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MO",
            "license": "R9286",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "501887806",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SSM Health Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Evan Jubae Smith, DC
• Lisa Anne Smith, NP-C
• Daniella Rae Spencer, LPC
• SSM Cardinal Glennon Children's Hospital (SSM Health Cardinal Glennon Pediatrics)
• SSM Medical Group Inc. (SSM Health Medical Group)
• Sstar LLC
• St. Louis Dermatology & Cosmetic Surgery
• Starling Counseling & Consulting
• Heather Stewart, PTA
• Samantha Joann Stolle, DC

• Internal Medicine Physician in Troy, MO
• Providers in Troy, MO by specialty
• Internal Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2016; 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.