SSM Health Care St. Louis
Organization Active NPI General Acute Care Hospital · Fenton, MO
NPI 1851496152 · NPPES record last updated Nov 27, 2023
Key facts
- NPI
- 1851496152
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Acute Care Hospital 282N00000X
- License
- 456-6 (MO)
- Legal business name
- SSM HEALTH CARE ST. LOUIS
- Practice address
- 1015 Bowles Ave
Fenton, MO 63026-2394 - Phone
- (636) 496-2000
- NPI assigned
- Sep 13, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- SSM HEALTH CARE CORPORATION
Authorized official
- Name
- Ms. Tina Garrison
- Title
- President
- Phone
- (636) 496-2502
Parent organization (reported in NPPES) 1
Owners & managing parties with NPI records 14
-
Snehal R Gandhi, M.D.
Owned or controlled facilities with NPI records 11
Other NPIs with the same Medicare PAC ID 13
Corporate family (same tax ID) 14
Member of 1
Facilities with the same owner 31
Practitioners 214
-
Hari Thanigaraj Srihari, M.D.
-
Brendan Alleyne, MD
-
Issam Atallah, MD
-
Nichole L Aulisio, FNP, APRN
-
Shelia Austin, LCSW
-
Elie C Azrak, MD
-
Bruce Matathias Baskir, M.D.
-
Mark Beidle, MSW, LCSW
-
Candace Danielle Benford, PMHNP
-
Laura Billadello, MD
-
Sam G. Bishara, M.D.
-
Mark T Boschert, M.D.
-
Kenisha Leandra Bryant, WHNP
-
Erin Lyn Bufford, LPC
-
Kelli Elizabeth Buntaine, FNP-C
-
Frank S. Calandrino Jr., M.D.
-
Georges Chahoud, MD
-
Angela Lynn Chandler, FNP-BC
-
Christine C Cortadillo, D.O.
Affiliated clinicians 504
-
Syed A Abdul Khader, M.D.
-
Sreenu Ada, MD
-
Lindsey Danielle Adams, NP-C
-
Kent L Adkins, MD
-
Ramona Aitken, MD
-
Nada Al Masalmeh, M.D.
-
Najat A. Al-Sherri, M.D.
-
Ashley Haegele Ali, M.D.
-
Zain Ali, M.D.
-
Saad Alkaade, M.D.
-
Rebekah Allen, DO
-
Kristina Marie Anderson, M.D.
-
Alexis Chris Argoudelis, M.D.
-
Shilpkumar Arora, MD MPH
-
Leslie Artinger, CRNA
-
Asim Ayaz, M.D.
-
Elie C Azrak, MD
Medicare Care Compare: Hospital
- Listed as
- SSM St Clare Health Center
- Overall star rating
- ★★★★☆ 4 of 5
- Type
- Acute Care Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Hospital certification: CCN 260081
- Legal name
- SSM HEALTH CARE ST LOUIS
- Doing business as
- SSM HEALTH ST. CLARE HOSPITAL - FENTON
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Jul 1, 1966
- Last certification
- Jul 10, 2013
- Beds
- 180
- Ownership / control type
- Private (not for profit)
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 1015 Bowles Ave
Fenton, MO 63026-2394 - Hospital subgroups
- Acute care
All disclosed owners & managing parties 19
| Name | Role | Since | Share |
|---|---|---|---|
| Kevin Smith |
Corporate Officer |
Oct 1, 2023 | |
| Christine K Jacobs |
Corporate Director | Dec 20, 2021 | |
| Snehal R Gandhi |
Corporate Director |
May 1, 2017 | |
| Kevin Elledge |
Corporate Director |
Apr 2, 2021 | |
| Douglass Petty |
Corporate Director |
Jun 1, 2019 | |
| Jeremy M Fotheringham |
Corporate Officer |
Apr 2, 2021 | |
| Corporate Director |
Apr 2, 2021 | ||
| Timothy Allen Johnson |
Corporate Director | Dec 17, 2021 | |
| Douglas P Long |
Corporate Director |
Jun 1, 2019 | |
| SSM Health Care Corporation |
5% Or Greater Indirect Ownership Interest | Sep 1, 2015 | 85% |
| Dennis Harms |
Corporate Director |
Jun 1, 2019 | |
| Eileen Lamm |
Corporate Officer |
Mar 23, 2020 | |
| Operational/Managerial Control |
Mar 23, 2020 | ||
| SSM Health Care St Louis |
5% Or Greater Direct Ownership Interest | Sep 1, 2015 | 100% |
| St Louis University |
5% Or Greater Indirect Ownership Interest | Sep 1, 2015 | 15% |
| Timothy Buller |
Corporate Officer |
Oct 9, 2013 | |
| Operational/Managerial Control |
Oct 9, 2013 | ||
| Kyle a Grate |
Corporate Director | Jan 26, 2022 | |
| W-2 Managing Employee |
Jan 26, 2022 | ||
| Joseph Yancey |
Corporate Director |
Apr 2, 2021 | |
| Laura Kaiser |
Corporate Officer |
May 1, 2017 | |
| Steven Smoot |
Corporate Officer |
Jan 1, 2020 | |
| Corporate Director |
Aug 8, 2018 | ||
| Jan Cerny |
Corporate Officer |
Apr 2, 2021 | |
| Corporate Director |
Sep 1, 2015 |
All facility ownership & control disclosures 10
| Facility | Type | Role | Since |
|---|---|---|---|
| SSM Health Rehabilitation Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (49%) | May 1, 2009 |
| SSM Health Saint Louis University Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 2015 |
| SSM Health Saint Louis University Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 2015 |
| SSM Health St Joseph Hospital - Lake Saint Louis |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Sep 17, 2014 |
| SSM Health St Joseph Hospital - St Charles |
Hospital | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control |
Sep 11, 1984 Oct 12, 2015 |
| SSM Health St. Mary'S Hospital - St. Louis |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jan 13, 2014 |
| SSM Health St. Mary'S Hospital - St Louis |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Sep 11, 1984 |
| SSM Health Depaul Hospital St Louis |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Dec 16, 2013 |
| SSM Health Depaul Hospital - St Louis |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Oct 10, 2014 |
| SSM Health Depaul Hospital - Anna House |
Skilled nursing facility | 5% Or Greater Indirect Ownership Interest (100%) | Sep 1, 2015 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040107000362 | MO | Part a Provider - Hospital | 7810800737 | Practice locations: Fenton, MO; Saint Louis, MO; Arnold, MO |
National Provider Directory
- Tax ID family
- Good Samaritan RHC Wayn
- Part of
- SSM Health Care Corporation
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Acute Care Hospital | 282N00000X | 456-6 | MO | Yes |
Addresses
Primary practice location
1015 Bowles Ave
Fenton, MO 63026-2394
Mailing address
1015 Bowles Ave
Fenton, MO 63026-2394
Phone (636) 496-2000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 14878046 | Other | MO | MISSOURI STATE TAX ID # |
| 010417202 | Medicaid | MO |
Other names
- SSM Health St. Clare Hospital - Fenton
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other |
Other providers in Fenton, MO
- South County Anesthesia Associates, LTD
- Specialt MRI, LLC
- Angela Rae Sqrow
- Hari Thanigaraj Srihari
- SSM Health Care St Louis
- SSM Medical Group
- SSM Medical Group
- SSM Medical Group
- SSM Medical Group Inc.
- SSM Medical Group, Inc.
All providers in Fenton, MO · General Acute Care Hospital in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 27, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.