NPIMap

Organization Active NPI

SSM Regional Health Services

Doing business as St. Marys Cancer Specialist

  • Oncology Clinic/Center
  • Jefferson City, MO
National Provider Identifier
1619923240
Registry record updated Jul 28, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oncology Clinic/CenterTaxonomy code 261QX0200X
Legal business name
SSM REGIONAL HEALTH SERVICES
Doing business as
St. Marys Cancer Specialist
Practice address
200 Saint Marys PLZ
Ste 202
Jefferson City, MO 65101-1604
Phone
(573) 761-0457
Fax
(573) 761-0459
NPI assigned
May 25, 2006
Last updated
Jul 28, 2007By the provider in NPPES
Organization subpart
Yes
Parent organization
SSM REGIONAL HEALTH SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 28, 2007

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

Authorized official

Name
Brent Van Conia
Title
President
Phone
(573) 761-7000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oncology Clinic/Center 261QX0200X Primary

Addresses

Primary practice location

200 Saint Marys PLZ
Ste 202
Jefferson City, MO 65101-1604

Mailing address

PO Box 1027
Jefferson City, MO 65102-1027
Phone (573) 761-7246

Other names 1

  • St. Marys Cancer Specialist Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040107000402 MO Part B Supplier - Clinic/Group Practice 8921917352 Receives reassigned benefits from 16 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jefferson City, MO

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
SSM Regional Health Ser

Locations

200 Saint Marys Plz
Ste 202
Jefferson Cty, MO 65101
Phone (573) 761-0457

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185580800000",
    "number": "1619923240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1027",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651021027",
            "telephone_number": "573-761-7246",
            "fax_number": "573-761-6947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 SAINT MARYS PLZ",
            "address_2": "STE 202",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651011604",
            "telephone_number": "573-761-0457",
            "fax_number": "573-761-0459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SSM REGIONAL HEALTH SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SSM REGIONAL HEALTH SERVICES",
        "enumeration_date": "2006-05-25",
        "last_updated": "2007-07-28",
        "status": "A",
        "authorized_official_last_name": "VAN CONIA",
        "authorized_official_first_name": "BRENT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "573-761-7000"
    },
    "taxonomies": [
        {
            "code": "261QX0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Marys Cancer Specialist",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jefferson City, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2007; 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.