NPIMap

Organization Active NPI

SSM Depaul Medical Group, Inc.

Doing business as DePaul Medical Group at Cross Keys

  • Family Medicine Physician
  • Florissant, MO
National Provider Identifier
1952312951
Registry record updated Nov 18, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SSM DEPAUL MEDICAL GROUP, INC.
Doing business as
DePaul Medical Group at Cross Keys
Practice address
14021 New Halls Ferry Rd
Florissant, MO 63033-2708
Phone
(314) 839-0910
Fax
(314) 839-9053
NPI assigned
Aug 11, 2006
Last updated
Nov 18, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
SSM DEPAUL MEDICAL GROUPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 18, 2010

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

Authorized official

Name
Ms. Laura Lynn Pullum
Title
Director of Patient Accounts
Phone
(636) 669-2434

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary
Pediatrics Physician 208000000X
Podiatrist 213E00000X

Addresses

Primary practice location

14021 New Halls Ferry Rd
Florissant, MO 63033-2708

Mailing address

1551 Wall St
Suite 310
Saint Charles, MO 63303-3541
Phone (636) 669-2268

Other identifiers 1

IdentifierTypeStateIssuer
6438130003OtherMOMEDICARE DME

Other names 1

  • DePaul Medical Group at Cross Keys Doing business as

National Provider Directory

National Provider Directory
Tax ID family
SSM Depaul Medical Group Inc13 organizations share this tax ID, including this one
Part of
SSM Depaul Medical Group Inc

Other organizations with this tax ID 12

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

Locations

12255 De Paul Dr
Ste 5
Bridgeton, MO 63044

12266 De Paul Dr
Ste 315
Bridgeton, MO 63044
Phone (314) 739-5858

12277 De Paul Dr
Ste 403
Bridgeton, MO 63044
Phone (314) 344-7585

3440 De Paul Ln
Ste 113
Bridgeton, MO 63044
Phone (314) 942-6464

5 Hollenberg Ct
Bridgeton, MO 63044

1015 Bowles Ave
Ste 1100
Fenton, MO 63026

1120 Shackelford Rd
Florissant, MO 63031
Phone (314) 830-5805

1224 Graham Rd
Ste 3009
Florissant, MO 63031
Phone (314) 839-7500

493 Rue Saint Francois St
Ste 2
Florissant, MO 63031
Phone (314) 837-2818

100 Medical Plz
Ste 140
Lake Saint Louis, MO 63367

300 Medical Plz
Ste 221
Lake St Louis, MO 63367
Phone (636) 561-2229

2022 Dorsett Vlg
Maryland Heights, MO 63043
Phone (314) 520-0520

1475 Kisker Rd
Ste 100
Saint Charles, MO 63304
Phone (636) 332-8455

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

916 Olive St
Unit 8
Saint Louis, MO 63101

Practitioners & affiliated clinicians

Practitioners 199

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 199

NPI Registry JSON

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1290038400000",
    "number": "1952312951",
    "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": "633033541",
            "telephone_number": "636-669-2268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14021 NEW HALLS FERRY RD",
            "city": "FLORISSANT",
            "state": "MO",
            "postal_code": "630332708",
            "telephone_number": "314-839-0910",
            "fax_number": "314-839-9053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SSM DEPAUL MEDICAL GROUP, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SSM DEPAUL MEDICAL GROUP",
        "enumeration_date": "2006-08-11",
        "last_updated": "2010-11-18",
        "status": "A",
        "authorized_official_last_name": "PULLUM",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "DIRECTOR OF PATIENT ACCOUNTS",
        "authorized_official_telephone_number": "636-669-2434",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE DME",
            "identifier": "6438130003",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DePaul Medical Group at Cross Keys",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Florissant, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2010; 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.