NPIMap

Organization Active NPI

St. Mary Medical Center

  • Internal Medicine Physician
  • Merrillville, IN
National Provider Identifier
1457425605
Registry record updated Jul 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
ST. MARY MEDICAL CENTER
Practice address
300 W 80TH PL
Ste a
Merrillville, IN 46410-5456
Phone
(219) 738-1736
Fax
(219) 738-2482
NPI assigned
Nov 20, 2006
Last updated
Jul 11, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2024

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

Authorized official

Name
Mary F Sudicky
Title
Chief Financial Officer
Phone
(219) 942-0551

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X Primary

Addresses

Primary practice location

300 W 80TH PL
Ste a
Merrillville, IN 46410-5456

Mailing address

164 Bracken Pkwy
Hobart, IN 46342-6789
Phone (219) 947-6780

Other identifiers 1

IdentifierTypeStateIssuer
200251650GMedicaidIN

National Provider Directory

National Provider Directory
Tax ID family
Ancilla Health Services5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720656000000",
    "number": "1457425605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "164 BRACKEN PKWY",
            "city": "HOBART",
            "state": "IN",
            "postal_code": "463426789",
            "telephone_number": "219-947-6780",
            "fax_number": "219-947-6778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 W 80TH PL",
            "address_2": "STE A",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464105456",
            "telephone_number": "219-738-1736",
            "fax_number": "219-738-2482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. MARY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "last_updated": "2024-07-11",
        "certification_date": "2024-07-11",
        "status": "A",
        "authorized_official_last_name": "SUDICKY",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "219-942-0551"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200251650G",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Merrillville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2024; 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.