NPIMap

Organization Active NPI

SSM Regional Health Services

Doing business as SSM Health Cancer Center

  • Radiation Oncology Clinic/Center
  • Jefferson City, MO
National Provider Identifier
1639508146
Registry record updated Dec 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology Clinic/CenterTaxonomy code 261QX0203X
Legal business name
SSM REGIONAL HEALTH SERVICES
Doing business as
SSM Health Cancer Center
Practice address
1241 W Stadium Blvd
Jefferson City, MO 65109-6023
Phone
(573) 556-7700
NPI assigned
Nov 5, 2013
Last updated
Dec 16, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
SSM REGIONAL HEALTH SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 16, 2025

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

Authorized official

Name
Shasta Rene Manuel
Title
Regional Vice President Finance/Cfo
Phone
(405) 272-7282

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Clinic/Center 261QX0203X NU Primary

Addresses

Primary practice location

1241 W Stadium Blvd
Jefferson City, MO 65109-6023

Mailing address

7655 Solutions Ctr
Chicago, IL 60677-7006
Phone (557) 203-1551

Other names 1

  • SSM Health Cancer Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061213000117 MO Part B Supplier - Clinic/Group Practice 8921917352 Receives reassigned benefits from 3 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
Tax ID family
St Marys Health Center14 organizations share this tax ID, including this one
Part of
St Marys Health Center

Other organizations with this tax ID 13

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

View all 13

Locations

1241 W Stadium Blvd
Jefferson Cty, MO 65109
Phone (573) 556-5771

Practitioners & affiliated clinicians

Practitioners 3

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": "1383609600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765843200000",
    "number": "1639508146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7655 SOLUTIONS CTR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606777006",
            "telephone_number": "557-203-1551",
            "fax_number": "314-989-6721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1241 W STADIUM BLVD",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651096023",
            "telephone_number": "573-556-7700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SSM REGIONAL HEALTH SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SSM REGIONAL HEALTH SERVICES",
        "enumeration_date": "2013-11-05",
        "last_updated": "2025-12-16",
        "certification_date": "2025-12-16",
        "status": "A",
        "authorized_official_last_name": "MANUEL",
        "authorized_official_first_name": "SHASTA",
        "authorized_official_middle_name": "RENE",
        "authorized_official_title_or_position": "REGIONAL VICE PRESIDENT FINANCE/CFO",
        "authorized_official_telephone_number": "405-272-7282"
    },
    "taxonomies": [
        {
            "code": "261QX0203X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oncology, Radiation",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SSM Health Cancer Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SSM Health Cancer Center",
            "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 Dec 16, 2025; 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.