NPIMap

Organization Active NPI

SSM Regional Health Services

Doing business as SSM Health Medical Group - Family Medicine

  • Family Medicine Physician
  • Jefferson City, MO
National Provider Identifier
1669856829
Registry record updated Dec 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SSM REGIONAL HEALTH SERVICES
Doing business as
SSM Health Medical Group - Family Medicine
Practice address
2511 W Edgewood Dr Ste F
Jefferson City, MO 65109-5869
Phone
(573) 761-7979
Fax
(573) 761-0445
NPI assigned
Jul 16, 2015
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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU
Family Medicine Physician 207Q00000X MO Primary

Addresses

Primary practice location

2511 W Edgewood Dr Ste F
Jefferson City, MO 65109-5869

Mailing address

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

Other names 1

  • SSM HEALTH MEDICAL GROUP - FAMILY MEDICINE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070316000022 MO Part B Supplier - Clinic/Group Practice 8921917352 Receives reassigned benefits from 17 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

Practitioners & affiliated clinicians

Practitioners 1

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": "1437004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765843200000",
    "number": "1669856829",
    "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": "2511 W EDGEWOOD DR STE F",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651095869",
            "telephone_number": "573-761-7979",
            "fax_number": "573-761-0445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SSM REGIONAL HEALTH SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SSM REGIONAL HEALTH SERVICES",
        "enumeration_date": "2015-07-16",
        "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": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SSM HEALTH MEDICAL GROUP - FAMILY MEDICINE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SSM HEALTH MEDICAL GROUP - FAMILY MEDICINE",
            "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.