NPIMap

Organization Active NPI

SSM St. Charles Clinic Medical Group, Inc.

Doing business as SSM Health Medical Group

  • Family Medicine Physician
  • Saint Charles, MO
National Provider Identifier
1811932973
Registry record updated Jan 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SSM ST. CHARLES CLINIC MEDICAL GROUP, INC.
Doing business as
SSM Health Medical Group
Practice address
1551 Wall St
Suite 400
Saint Charles, MO 63303-3539
Phone
(636) 669-2350
Fax
(636) 669-2221
NPI assigned
Jun 20, 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 Pullum
Title
Billing Manager
Phone
(636) 669-2434

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary
Internal Medicine Physician 207R00000X NU
Obstetrics & Gynecology Physician 207V00000X NU
Pediatrics Physician 208000000X NU
Surgery Physician 208600000X NU
Vascular Surgery Physician 2086S0129X NU

Addresses

Primary practice location

1551 Wall St
Suite 400
Saint Charles, MO 63303-3539

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
501133607MedicaidMO

Other names 1

  • SSM Health Medical Group Doing business as

National Provider Directory

National Provider Directory

Locations

300 Medical Plz
Ste 150
Lake St Louis, MO 63367
Phone (636) 625-2662

300 Medical Plz
Ste 31
Lake St Louis, MO 63367
Phone (636) 625-2662

Practitioners & affiliated clinicians

Practitioners 61

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 61

NPI Registry JSON

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

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452816000000",
    "number": "1811932973",
    "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": "1551 WALL ST",
            "address_2": "SUITE 400",
            "city": "SAINT CHARLES",
            "state": "MO",
            "postal_code": "633033539",
            "telephone_number": "636-669-2350",
            "fax_number": "636-669-2221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SSM ST. CHARLES CLINIC MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-20",
        "last_updated": "2016-01-15",
        "status": "A",
        "authorized_official_last_name": "PULLUM",
        "authorized_official_first_name": "LAURA",
        "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": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "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": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "501133607",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SSM Health Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Charles, 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.