NPIMap

Organization Active NPI

SSM Medical Group Inc.

Doing business as SSM Health Medical Group

  • Durable Medical Equipment & Medical Supplies
  • Bridgeton, MO
National Provider Identifier
1477564581
Registry record updated Aug 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
SSM MEDICAL GROUP INC.
Doing business as
SSM Health Medical Group
Practice address
12255 De Paul Dr
Suite 500
Bridgeton, MO 63044
Phone
(314) 209-5180
Fax
(314) 209-5153
NPI assigned
Aug 11, 2006
Last updated
Aug 18, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
SSM MEDICAL GROUP INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 18, 2020

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

Authorized official

Name
Karen Rewerts
Title
VP Financial Operations
Phone
(314) 989-2034

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Endocrinology, Diabetes & Metabolism PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RE0101X
Pulmonary Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RP1001X
PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213E00000X MO
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

12255 De Paul Dr
Suite 500
Bridgeton, MO 63044

Mailing address

3221 McKelvey Rd Ste 301
Bridgeton, MO 63044-2551
Phone (636) 498-5944

Other names 1

  • SSM Health Medical Group Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181115000997 MO DME Supplier - Physician - Podiatry 6608776299 Practice locations: Bridgeton, MO

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

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

Other organizations with this tax ID 12

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

Locations

12255 De Paul Dr
Ste 500
Bridgeton, MO 63044
Phone (314) 209-5180

NPI Registry JSON

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597708800000",
    "number": "1477564581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3221 MCKELVEY RD STE 301",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442551",
            "telephone_number": "636-498-5944",
            "fax_number": "314-209-8127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12255 DE PAUL DR",
            "address_2": "SUITE 500",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "63044",
            "telephone_number": "314-209-5180",
            "fax_number": "314-209-5153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SSM MEDICAL GROUP INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SSM MEDICAL GROUP INC.",
        "enumeration_date": "2006-08-11",
        "last_updated": "2020-08-18",
        "certification_date": "2020-08-18",
        "status": "A",
        "authorized_official_last_name": "REWERTS",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "VP FINANCIAL OPERATIONS",
        "authorized_official_telephone_number": "314-989-2034"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": "MO",
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SSM Health Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bridgeton, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2020; 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.