NPIMap

Organization Active NPI

SSM Regional Health Services

Doing business as SSM Health Medical Group - Family Medicine

  • Clinic/Center
  • Holts Summit, MO
National Provider Identifier
1952357352
Registry record updated Dec 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
SSM REGIONAL HEALTH SERVICES
Doing business as
SSM Health Medical Group - Family Medicine
Practice address
140 Northstar Dr
Holts Summit, MO 65043-1123
Phone
(573) 896-8301
Fax
(573) 896-8589
NPI assigned
May 26, 2006
Last updated
Dec 16, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
SSM REGIONAL HEALTH SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 16, 2025

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

Authorized official

Name
Shasta Rene Manuel
Title
Regional Vice President-Finance/Cfo
Phone
(405) 272-7282

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary

Addresses

Primary practice location

140 Northstar Dr
Holts Summit, MO 65043-1123

Mailing address

7655 Solutions Ctr
Chicago, IL 60677-7006
Phone (557) 203-1551

Other identifiers 1

IdentifierTypeStateIssuer
502624307MedicaidMO

Other names 1

  • SSM Health Medical Group - Family Medicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040819000270 MO Part B Supplier - Clinic/Group Practice 8921917352 Receives reassigned benefits from 14 practitioners
Practice locations: Holts Summit, MO

Other NPIs with the same Medicare PAC ID 12

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D0445898SSM Health Medical Group Family Medicine140 Northstar, Holts Summit, MO 65043Certificate of waiverOct 29, 2027

National Provider Directory

National Provider Directory
Tax ID family
St Marys Health Center14 organizations share this tax ID, including this one
Part of
St Marys Health Center

Other organizations with this tax ID 13

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

View all 13

Ownership & related parties

All facility ownership & control disclosures 8

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
SSM Health St Marys Hospital Jefferson CityJefferson City, MO, CCN 260011 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2000
SSM Health Good Samaritan Hospital - Mt. VernonMount Vernon, IL, CCN 140046 Hospital 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2015
SSM Health St. Mary's Hospital-CentraliaCentralia, IL, CCN 14S034 Hospital 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2015
SSM Health St. Mary's Hospital - CentraliaCentralia, IL, CCN 140034 Hospital 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2015
SSM Health Good Samaritan Hospital - Mt VernonMount Vernon, IL, CCN 14T046 Hospital 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2015
SSM Health Medical GroupCentralia, IL, CCN 783803 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2008
SSM Health Medical Group Family MedicineBelle, MO, CCN 268678 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Nov 16, 2014
SSM Health Medical Group Family MedicineTipton, MO, CCN 268703 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Dec 22, 1999

Owned or controlled facilities with NPI records 8

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765843200000",
    "number": "1952357352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7655 SOLUTIONS CTR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606777006",
            "telephone_number": "557-203-1551",
            "fax_number": "314-989-6721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 NORTHSTAR DR",
            "city": "HOLTS SUMMIT",
            "state": "MO",
            "postal_code": "650431123",
            "telephone_number": "573-896-8301",
            "fax_number": "573-896-8589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SSM REGIONAL HEALTH SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SSM REGIONAL HEALTH SERVICES",
        "enumeration_date": "2006-05-26",
        "last_updated": "2025-12-16",
        "certification_date": "2025-12-16",
        "status": "A",
        "authorized_official_last_name": "MANUEL",
        "authorized_official_first_name": "SHASTA",
        "authorized_official_middle_name": "RENE",
        "authorized_official_title_or_position": "REGIONAL VICE PRESIDENT-FINANCE/CFO",
        "authorized_official_telephone_number": "405-272-7282"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "502624307",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SSM Health Medical Group - Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SSM Health Medical Group - Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Holts Summit, MO

Sources for this page

Verify at the official NPI Registry.