St Margaret Mercy Healthcare Centers

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

ST MARGARET MERCY HEALTHCARE CENTERS

Doing business as

St Margaret Mercy Behavioral Health Outpatient Center

Practice address

312 Ridge Road
Munster, IN 46321-1528

Phone

(219) 322-5747

Fax

(219) 864-2282

NPI assigned

Nov 14, 2006

Reactivated

Nov 24, 2008

Last updated

Nov 25, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Thomas Gryzbek

Title

President

Phone

(219) 932-2300

Specialties & licenses 8

Addresses

Other identifiers 1

Other names 1

• St Margaret Mercy Behavioral Health Outpatient Center Doing business as

Practitioners 3

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.

• Charles Mok Jr., DO

  • Family Medicine Physician
  • Griffith, IN
  • NPI 1205828258
  NPD (past)
• Angela Martinez, M.D.

  • Family Medicine Physician
  • Wenona, IL
  • NPI 1386671709
  NPD (past)
• Theodore Lyons Stern, MD

  • Family Medicine Physician
  • Westmont, IL
  • NPI 1043202567
  NPD (past)

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1227571200000",
    "number": "1861564361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1000",
            "city": "DYER",
            "state": "IN",
            "postal_code": "463110800",
            "telephone_number": "218-322-5747",
            "fax_number": "219-864-2282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 RIDGE ROAD",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463211528",
            "telephone_number": "219-322-5747",
            "fax_number": "219-864-2282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST MARGARET MERCY HEALTHCARE CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2008-11-25",
        "deactivation_date": "2007-12-07",
        "reactivation_date": "2008-11-24",
        "status": "A",
        "authorized_official_last_name": "GRYZBEK",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "219-932-2300"
    },
    "taxonomies": [
        {
            "code": "364SP0807X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health, Child & Adolescent",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100462480",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Margaret Mercy Behavioral Health Outpatient Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bassem Srour, M.D.
• St Catherine Hospital Inc (Powers Health Pharmacy)
• St Catherine Hospital Inc (Powers Health Pharmacy)
• James Benjamin St Clair, MD, PHD
• St Margaret Mercy Healthcare Centers (Munster Medical Services)
• St Margaret Mercy Healthcare Centers, Inc. (Munster Medical Services)
• St. Margaret Mercy Healthcare Centers Inc (Munster Orthopedic Clinic)
• St. Margaret Mercy Healthcare Centers Inc (Munster Surgical)
• St. Margaret Mercy Healthcare Centers, Inc (Munster Orthopedic Clinic)
• Stand Up Open MRI of Indiana LLC

• Psychiatry Physician in Munster, IN
• Providers in Munster, IN by specialty
• Psychiatry Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 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.