NPIMap

Organization Active NPI

Saint Medical Group, LLC

Doing business as SSM Health Shawnee Ambulatory Care

  • Family Medicine Physician
  • Shawnee, OK
National Provider Identifier
1306447172
Registry record updated Sep 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SAINT MEDICAL GROUP, LLC
Doing business as
SSM Health Shawnee Ambulatory Care
Practice address
4651 N Harrison
Shawnee, OK 74804
Phone
(405) 273-5801
Fax
(405) 878-3794
NPI assigned
Nov 6, 2020
Last updated
Sep 2, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2025

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

Authorized official

Name
Shasta R Manuel
Title
Vice President - Finance
Phone
(405) 272-7282

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X
Family Medicine Physician 207Q00000X Primary
Obstetrics & Gynecology Physician 207V00000X
Physical Medicine & Rehabilitation Physician 208100000X
Diagnostic Radiology Physician 2085R0202X

Addresses

Primary practice location

4651 N Harrison
Shawnee, OK 74804

Mailing address

PO Box 958210
Saint Louis, MO 63195-8210
Phone (405) 231-3857

Other practice location 1

2749 Progressive Dr
Suite B
Edmond, OK 73034
Phone (405) 772-4110

Other names 1

  • SSM Health Shawnee Ambulatory Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Shawnee Medical Center Clinic Inc13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

NPI Registry JSON

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

{
    "created_epoch": "1604620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756771200000",
    "number": "1306447172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 958210",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631958210",
            "telephone_number": "405-231-3857",
            "fax_number": "405-272-7977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4651 N HARRISON",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "74804",
            "telephone_number": "405-273-5801",
            "fax_number": "405-878-3794"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2749 Progressive Dr",
            "address_2": "Suite B",
            "address_purpose": "LOCATION",
            "city": "Edmond",
            "state": "OK",
            "postal_code": "73034",
            "country_code": "US",
            "telephone_number": "405-772-4110",
            "fax_number": "405-772-4115",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SAINT MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-06",
        "last_updated": "2025-09-02",
        "certification_date": "2024-03-20",
        "status": "A",
        "authorized_official_last_name": "MANUEL",
        "authorized_official_first_name": "SHASTA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "VICE PRESIDENT - FINANCE",
        "authorized_official_telephone_number": "405-272-7282"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SSM Health Shawnee Ambulatory Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shawnee, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2025; 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.