St. Marys Hospital

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

36114675 Issued in IL

Legal business name

ST. MARYS HOSPITAL

Doing business as

St. Mary's Prairie Cardiology

Practice address

104 W 6TH St
Streator, IL 61364-2899

Phone

(815) 672-8741

NPI assigned

Jan 11, 2008

Organization subpart

Yes

Parent organization

ST. MARY'S HOSPITALAs reported in NPPES

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

Authorized official

Name

Karen S Clark

Title

Cfo

Phone

(815) 673-4514

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• St. Mary's Prairie Cardiology Doing business as

Tax ID family

St Mary'S Hospital Streator Hospital Sisters of the 3Rd Order St Fran3 organizations share this tax ID, including this one

Part of

St Mary'S Hospital Streator Hospital Sisters of the 3Rd Order St Fran

Other organizations with this tax ID 2

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

• St Marys Hospital

  • Urology Physician
  • Streator, IL
  • NPI 1770710360
  NPD tax ID
• St. Mary'S Hospital

  • Rural Acute Care Hospital
  • Streator, IL
  • NPI 1750709630
  NPD tax ID

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

{
    "created_epoch": "1200009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228867200000",
    "number": "1699951483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 W 6TH ST",
            "city": "STREATOR",
            "state": "IL",
            "postal_code": "613642899",
            "telephone_number": "815-672-8741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 W 6TH ST",
            "city": "STREATOR",
            "state": "IL",
            "postal_code": "613642899",
            "telephone_number": "815-672-8741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. MARYS HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. MARY'S HOSPITAL",
        "enumeration_date": "2008-01-11",
        "last_updated": "2008-12-10",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "815-673-4514"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IL",
            "license": "36114675",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "5032110",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MD NPI",
            "identifier": "1669451233",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "220782977",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Mary's Prairie Cardiology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• St Marys Hospital Streator Hospital Sisters of the 3Rd Ordr St Francis
• St. Margaret'S Health-Peru
• St. Mary'S Hospital
• St. Mary'S Hospital
• St. Mary'S Hospital Streator Hospital Sisters of the 3Rd Order St Fran
• Kelly Lynn Stiles, LMT
• Kimberly Stoffle
• Streator Chidlrens Clinic
• Streator Elem School Dist 44
• Streator Emergency Medical Services Inc

• Cardiovascular Disease Physician in Streator, IL
• Providers in Streator, IL by specialty
• Cardiovascular Disease Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.