St. Joseph Primary LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

ST. JOSEPH PRIMARY LLC

Doing business as

Lincoln Rd. Surgeons

Practice address

2343 W Lincoln Rd
Kokomo, IN 46902-8012

Phone

(765) 455-4090

Fax

(765) 457-4443

NPI assigned

Jul 25, 2007

Last updated

Nov 16, 2007By 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

Mr. Andrew Kellar

Title

Regional Practice Administrator

Phone

(765) 457-8381

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Lincoln Rd. Surgeons Doing business as

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• St. Joseph Primary Care, LLC

  dba Ascension St. Vincent Kokomo Services

  • Family Medicine Physician
  • Kokomo, IN
  • NPI 1982736377

  O20040901000956

  Same enrollment

Locations

Practitioners 15

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.

• Lesley N Adibe, MD

  • Anesthesiology Physician
  • Kokomo, IN
  • NPI 1285775734
  NPD
• Stanton Angermeier, MD

  • Anesthesiology Physician
  • Kokomo, IN
  • NPI 1417939554
  NPD
• Claude Merrill Ashby, M.D.

  • Anesthesiology Physician
  • Kokomo, IN
  • NPI 1114925393
  NPD
• Evan Patrick Bickerstaff

  • Certified Registered Nurse Anesthetist
  • Kokomo, IN
  • NPI 1790588150
  NPD
• Jeffrey Nicholas Brentin, DO

  • Anesthesiology Physician
  • Kokomo, IN
  • NPI 1598256448
  NPD
• Alexander S Choi, MD

  • Anesthesiology Physician
  • Indianapolis, IN
  • NPI 1417988270
  NPD
• Melissa Anne Cogdell, CRNA

  • Certified Registered Nurse Anesthetist
  • Kokomo, IN
  • NPI 1003411604
  NPD
• Teethena Comeko Cooper, MD

  • Anesthesiology Physician
  • Shelbyville, IN
  • NPI 1730477324
  NPD
• Panchapakesan Pranatharthi Haran, MD

  • Anesthesiology Physician
  • Kokomo, IN
  • NPI 1467473330
  NPD
• Amy Hueston

  • Primary Care Nurse Practitioner
  • Kokomo, IN
  • NPI 1558905554
  NPD
• Elizabeth Tentler, DO

  • Anesthesiology Physician
  • Kokomo, IN
  • NPI 1154647998
  NPD
• Linda J Zynger, MD

  • Anesthesiology Physician
  • Indianapolis, IN
  • NPI 1245342401
  NPD

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

{
    "created_epoch": "1185321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195171200000",
    "number": "1295935484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2343 W LINCOLN RD",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469028012",
            "telephone_number": "765-455-4090",
            "fax_number": "765-457-4443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2343 W LINCOLN RD",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469028012",
            "telephone_number": "765-455-4090",
            "fax_number": "765-457-4443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOSEPH PRIMARY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-25",
        "last_updated": "2007-11-16",
        "status": "A",
        "authorized_official_last_name": "KELLAR",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "REGIONAL PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "765-457-8381",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "000000183506",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lincoln Rd. Surgeons",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• St. Joseph Primary Care LLC
• St. Joseph Primary Care LLC (Med One Two)
• St. Joseph Primary Care, LLC (Ascension St. Vincent Specialty Services)
• St. Joseph Primary Care, LLC
• St. Joseph Primary Care, LLC (Ascension St. Vincent Kokomo Services)
• St. Vincent Anderson Regional Hospital, Inc. (St. Vincent Home Medical)
• St. Vincent Health Wellness and Preventive Care Institute, Inc.
• St. Vincent Health Wellness and Preventive Care Institute, Inc.
• St. Vincent Hospice - Anderson LLC (Compassus - Southern Indiana)
• St. Vincent Medical Group, Inc. (Ascension Medical Group St. Vincent)

• Ambulatory Surgical Clinic/Center in Kokomo, IN
• Providers in Kokomo, IN by specialty
• Ambulatory Surgical Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2007; 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.