NPIMap

Organization Active NPI

Ssmdepaul Medical Group

  • Foot & Ankle Surgery Podiatrist
  • Saint Charles, MO
National Provider Identifier
1457660896
Registry record updated Oct 4, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
Legal business name
SSMDEPAUL MEDICAL GROUP
Practice address
1551 Wall St
Suite 400
Saint Charles, MO 63303-3539
Phone
(636) 669-2350
Fax
(636) 669-2221
NPI assigned
Oct 4, 2010
Last updated
Oct 4, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
SSM DEPAUL MEDICAL GROUPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 4, 2010

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

Authorized official

Name
Bridget Francis
Title
Credentilaing Coordinator
Phone
(636) 669-2268

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MO
Foot & Ankle Surgery Podiatrist 213ES0103X MO Primary

Addresses

Primary practice location

1551 Wall St
Suite 400
Saint Charles, MO 63303-3539

Mailing address

1551 Wall St
Suite 310
Saint Charles, MO 63303-3539
Phone (636) 669-2268

Other identifiers 1

IdentifierTypeStateIssuer
502915705MedicaidMO

National Provider Directory

National Provider Directory
Tax ID family
SSM Depaul Medical Group13 organizations share this tax ID, including this one
Part of
SSM Depaul Medical Group

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": "1286150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286150400000",
    "number": "1457660896",
    "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": "1551 WALL ST",
            "address_2": "SUITE 400",
            "city": "SAINT CHARLES",
            "state": "MO",
            "postal_code": "633033539",
            "telephone_number": "636-669-2350",
            "fax_number": "636-669-2221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SSMDEPAUL MEDICAL GROUP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SSM DEPAUL MEDICAL GROUP",
        "enumeration_date": "2010-10-04",
        "last_updated": "2010-10-04",
        "status": "A",
        "authorized_official_last_name": "FRANCIS",
        "authorized_official_first_name": "BRIDGET",
        "authorized_official_title_or_position": "CREDENTILAING COORDINATOR",
        "authorized_official_telephone_number": "636-669-2268"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": null,
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "MO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "502915705",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Charles, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2010; 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.