NPIMap

Organization Active NPI

SSM Depaul Medical Group, Inc.

Doing business as SSM Health Medical Group

  • Internal Medicine Physician
  • Maryland Heights, MO
National Provider Identifier
1760456743
Registry record updated Jan 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
SSM DEPAUL MEDICAL GROUP, INC.
Doing business as
SSM Health Medical Group
Practice address
2024 Dorsett VLG
Maryland Heights, MO 63043-2208
Phone
(314) 590-0550
Fax
(314) 590-0560
NPI assigned
Feb 15, 2006
Last updated
Jan 15, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2016

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

Authorized official

Name
Ms. Laura L Pullum
Title
Billing Manager
Phone
(636) 669-2434

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU
Internal Medicine Physician 207R00000X NU Primary
Pulmonary Disease Physician 207RP1001X NU
Rheumatology Physician 207RR0500X NU
Neurological Surgery Physician 207T00000X NU
Obstetrics & Gynecology Physician 207V00000X NU
Pediatrics Physician 208000000X NU
General Practice Physician 208D00000X NU

Addresses

Primary practice location

2024 Dorsett VLG
Maryland Heights, MO 63043-2208

Mailing address

1551 Wall St
Suite 310
Saint Charles, MO 63303-3539
Phone (636) 669-2268

Other identifiers 2

IdentifierTypeStateIssuer
502915705MedicaidMO
CJ7983OtherMORAILROAD MEDICARE

Other names 1

  • SSM Health Medical Group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
SSM Depaul Medical Group13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

800 School St
Carrollton, IL 62016
Phone (217) 942-3600

Practitioners & affiliated clinicians

Practitioners 437

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.

View all 437

NPI Registry JSON

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

{
    "created_epoch": "1139961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452816000000",
    "number": "1760456743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1551 WALL ST",
            "address_2": "SUITE 310",
            "city": "SAINT CHARLES",
            "state": "MO",
            "postal_code": "633033539",
            "telephone_number": "636-669-2268",
            "fax_number": "314-209-8127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2024 DORSETT VLG",
            "city": "MARYLAND HEIGHTS",
            "state": "MO",
            "postal_code": "630432208",
            "telephone_number": "314-590-0550",
            "fax_number": "314-590-0560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SSM DEPAUL MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-15",
        "last_updated": "2016-01-15",
        "status": "A",
        "authorized_official_last_name": "PULLUM",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "636-669-2434",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "502915705",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CJ7983",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SSM Health Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Maryland Heights, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2016; 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.