SSM Health Care St. Louis
Organization Active NPI General Acute Care Hospital · Bridgeton, MO
NPI 1598835308 · NPPES record last updated Aug 31, 2021
Key facts
- NPI
- 1598835308
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Acute Care Hospital 282N00000X
- License
- 414-11 (MO)
- Legal business name
- SSM HEALTH CARE ST. LOUIS
- Practice address
- 12303 De Paul Dr
Bridgeton, MO 63044-2512 - Phone
- (314) 344-6000
- NPI assigned
- Nov 9, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- SSM HEALTH CARE CORPORATION
Authorized official
- Name
- Ms. Tina Garrison
- Title
- President
- Phone
- (314) 344-7210
Parent organization (reported in NPPES) 1
Owners & managing parties with NPI records 15
-
Snehal R Gandhi, M.D.
-
Sriram Vissa, MD
Owned or controlled facilities with NPI records 11
Other NPIs with the same Medicare PAC ID 13
Corporate family (same tax ID) 14
Member of 2
Related certifications (CCN) 1
Facilities with the same owner 31
Practitioners 256
-
Ardaman S. Nanda, M.D.
-
Leslie A Scott, M.D.
-
Arun Venkat, M.D.
-
Brendan Alleyne, MD
-
Issam Atallah, MD
-
Nichole L Aulisio, FNP, APRN
-
Shelia Austin, LCSW
-
Elie C Azrak, MD
-
Bruce Matathias Baskir, M.D.
-
Mark Beidle, MSW, LCSW
-
Candace Danielle Benford, PMHNP
-
Laura Billadello, MD
-
Sam G. Bishara, M.D.
-
Mark T Boschert, M.D.
-
Kenisha Leandra Bryant, WHNP
-
Erin Lyn Bufford, LPC
-
Kelli Elizabeth Buntaine, FNP-C
-
Frank S. Calandrino Jr., M.D.
-
Georges Chahoud, MD
-
Angela Lynn Chandler, FNP-BC
Affiliated clinicians 617
-
Syed A Abdul Khader, M.D.
-
Daniel Adamovsky, DPM
-
Nathaniel Adams, MD
-
Susan R Adams, M.D.
-
Kent L Adkins, MD
-
Saima Ahmad, MD
-
Tauqir X Ahmed, MD
-
Ramona Aitken, MD
-
Roland Akinyede, M.D.
-
Amer Alshekhlee, MD
-
Pragna Ambadi, MD
-
Dustin M. Ambler, CRNA
-
Charmaine Ansari, MD
-
Venkat Arukala, M.D.
-
Romila Aslam, M.D.
-
Sara Atkinson, MSN, FNP-C
-
Ashley Shari Austin, ANP
-
Getinet Degu Ayalew, M.D.
-
Elie C Azrak, MD
-
Christina Azzam, CRNA
-
Robert D Baird, M.D.
Medicare Care Compare: Hospital
- Listed as
- SSM Health Depaul Hospital St Louis
- Overall star rating
- ★★★★☆ 4 of 5
- Type
- Acute Care Hospitals
- Ownership
- Voluntary non-profit - Church
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Hospital certification: CCN 260104
- Legal name
- SSM HEALTH CARE ST LOUIS
- Doing business as
- SSM HEALTH DEPAUL HOSPITAL - ST LOUIS
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Jul 7, 1969
- Last certification
- Nov 19, 2009
- Beds
- 538
- Ownership / control type
- Church
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 12303 De Paul Dr
Bridgeton, MO 63044-2512 - Hospital subgroups
- Acute care
All disclosed owners & managing parties 19
| Name | Role | Since | Share |
|---|---|---|---|
| Sriram Vissa |
Corporate Officer |
Jun 1, 2023 | |
| Kevin Smith |
Corporate Officer |
Oct 1, 2023 | |
| Christine K Jacobs |
Corporate Director | Dec 20, 2021 | |
| Snehal R Gandhi |
Corporate Director |
Aug 1, 2017 | |
| Kevin Elledge |
Corporate Director |
Apr 2, 2021 | |
| Douglass Petty |
Corporate Director |
Jun 1, 2019 | |
| Jeremy M Fotheringham |
Corporate Officer |
Apr 2, 2021 | |
| Corporate Director |
Apr 2, 2021 | ||
| Timothy Allen Johnson |
Corporate Director | Dec 17, 2021 | |
| Douglas P Long |
Corporate Officer |
Jun 1, 2019 | |
| SSM Health Care Corporation |
5% Or Greater Indirect Ownership Interest | Sep 1, 2015 | 85% |
| Dennis Harms |
Corporate Director |
Jun 1, 2019 | |
| Eileen Lamm |
Corporate Officer |
Mar 23, 2020 | |
| Operational/Managerial Control |
Mar 23, 2020 | ||
| SSM Health Care St Louis |
5% Or Greater Direct Ownership Interest | Oct 10, 2014 | 100% |
| St Louis University |
5% Or Greater Indirect Ownership Interest | Sep 1, 2015 | 15% |
| Timothy Buller |
Corporate Officer |
Sep 1, 2015 | |
| Operational/Managerial Control |
Oct 9, 2013 | ||
| Joseph Yancey |
Corporate Director |
Apr 2, 2021 | |
| Laura Kaiser |
Corporate Officer |
May 1, 2017 | |
| Steven Smoot |
Corporate Officer |
Jan 1, 2020 | |
| Corporate Director |
Aug 8, 2018 | ||
| Jan Cerny |
Corporate Officer |
Apr 2, 2021 | |
| Corporate Director |
Sep 1, 2015 |
All facility ownership & control disclosures 10
| Facility | Type | Role | Since |
|---|---|---|---|
| SSM Health St. Clare Hospital - Fenton |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 2015 |
| SSM Health Rehabilitation Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (49%) | May 1, 2009 |
| SSM Health Saint Louis University Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 2015 |
| SSM Health Saint Louis University Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 2015 |
| SSM Health St Joseph Hospital - Lake Saint Louis |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Sep 17, 2014 |
| SSM Health St Joseph Hospital - St Charles |
Hospital | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control |
Sep 11, 1984 Oct 12, 2015 |
| SSM Health St. Mary'S Hospital - St. Louis |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jan 13, 2014 |
| SSM Health St. Mary'S Hospital - St Louis |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Sep 11, 1984 |
| SSM Health Depaul Hospital St Louis |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Dec 16, 2013 |
| SSM Health Depaul Hospital - Anna House |
Skilled nursing facility | 5% Or Greater Indirect Ownership Interest (100%) | Sep 1, 2015 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160223002103 | MO | Part a Provider - Hospital | 7810800737 | Practice locations: Saint Charles, MO; Maryland Heights, MO; Lake St Louis, MO; Lake Saint Louis, MO; Florissant, MO; Bridgeton, MO |
National Provider Directory
- Tax ID family
- Good Samaritan RHC Wayn
- Part of
- SSM Health Care Corporation
Locations
7361 Solutions Ctr
Chicago, IL 60677
12266 De Paul Dr
Ste 206
Bridgeton, MO 63044
Phone (314) 209-5174
12266 De Paul Dr
Ste 310
Bridgeton, MO 63044
Phone (314) 209-5171
12266 De Paul Dr
Ste 306
Bridgeton, MO 63044
Phone (314) 209-5114
12255 De Paul Dr
Ste 501
Bridgeton, MO 63044
Phone (314) 209-5173
12349 De Paul Dr
Ste 110
Bridgeton, MO 63044
Phone (314) 209-7700
12255 De Paul Dr
Ste 600
Bridgeton, MO 63044
Phone (314) 209-5100
226 S Woods Mill Rd
Ste 62
Chesterfield, MO 63017
Phone (314) 469-3990
1120 Shackelford Rd
Ste B
Florissant, MO 63031
Phone (314) 830-5821
1120 Shackelford Rd
Florissant, MO 63031
Phone (314) 830-5805
300 1st Capitol Dr
Ste 230
Saint Charles, MO 63301
300 1st Capitol Dr
#230
Saint Charles, MO 63301
1027 Bellevue Ave
Ste 205
Saint Louis, MO 63117
Phone (314) 768-8730
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Acute Care Hospital | 282N00000X | 414-11 | MO | Yes |
Addresses
Primary practice location
12303 De Paul Dr
Bridgeton, MO 63044-2512
Mailing address
12303 De Paul Dr
Bridgeton, MO 63044-2512
Phone (314) 344-6000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100411820A | Medicaid | KS | |
| 149006105 | Medicaid | AR | |
| 1702471 | Medicaid | LA | |
| 911294400 | Medicaid | FL | |
| 01400001 | Medicaid | KY | |
| 540494101 | Medicaid | MO | |
| 72101326 | Medicaid | CO | |
| XHSP33320 | Medicaid | CA | |
| 010494102 | Medicaid | MO | |
| 0553719 | Medicaid | IA | |
| 200360100A | Medicaid | IN | |
| 431704972401 | Medicaid | IL | |
| 756053200 | Medicaid | MN | |
| 833203 | Medicaid | AZ | |
| XHSP43320 | Medicaid | CA | |
| 07184768 | Medicaid | MS | |
| 43170497200 | Medicaid | NE | |
| 431704972001 | Medicaid | IL |
Other names
- SSM Health DePaul Hospital - St. Louis
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Cobius Healthcare Solutions |
Other providers in Bridgeton, MO
- SSM Health Care St Louis
- SSM Health Care St. Louis
- SSM Health Care St. Louis
- SSM Health Care St. Louis
- SSM Health Care St. Louis
- SSM Medical Group Inc.
- SSM Medical Group Inc.
- SSM Medical Group Inc.
- SSM Neurosciences Inc
- SSM Pharmacy @ Depaul
All providers in Bridgeton, MO · General Acute Care Hospital in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 31, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.