NPIMap

Organization Active NPI

SSM Depaul Medical Group

  • Podiatrist
  • Saint Charles, MO
National Provider Identifier
1891123477
Registry record updated Oct 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
2004019662 Issued in MO
Legal business name
SSM DEPAUL MEDICAL GROUP
Practice address
1551 Wall St
Suite 400
Saint Charles, MO 63303-3539
Phone
(636) 669-2420
Fax
(636) 669-2401
NPI assigned
Oct 17, 2013
Last updated
Oct 17, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2013

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

Authorized official

Name
Laura Pullum
Title
Director
Phone
(636) 669-2434

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QA0505X
PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213E00000X 2004019662 MO Primary

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

National Provider Directory

National Provider Directory
Tax ID family
SSM Depaul Medical Group Inc13 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

1551 Wall St
Ste 400
Saint Charles, MO 63303
Phone (636) 462-6106

NPI Registry JSON

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

{
    "created_epoch": "1381968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381968000000",
    "number": "1891123477",
    "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": "636-669-2420",
            "fax_number": "636-669-2401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SSM DEPAUL MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-17",
        "last_updated": "2013-10-17",
        "status": "A",
        "authorized_official_last_name": "PULLUM",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "636-669-2434"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": "MO",
            "license": "2004019662",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Oct 17, 2013; 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.