NPIMap

Organization Active NPI

St. Joseph Primary Care, LLC

Doing business as Ascension St. Vincent Kokomo Services

  • Family Medicine Physician
  • Kokomo, IN
National Provider Identifier
1982736377
Registry record updated Feb 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
742949291 Issued in IN
Legal business name
ST. JOSEPH PRIMARY CARE, LLC
Doing business as
Ascension St. Vincent Kokomo Services
Practice address
1907 W Sycamore St
Kokomo, IN 46901-5148
Phone
(765) 456-5433
NPI assigned
Mar 12, 2007
Last updated
Feb 20, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2024

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

Authorized official

Name
Brian Morris
Title
Cfo (Amg)
Phone
(317) 338-6234

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X IN
Family Medicine Physician 207Q00000X 742949291 IN Primary
Internal Medicine Physician 207R00000X
Gastroenterology Physician 207RG0100X
Hepatology Physician 207RI0008X
Pediatrics Physician 208000000X
Pediatric Adolescent Medicine Physician 2080A0000X

Addresses

Primary practice location

1907 W Sycamore St
Kokomo, IN 46901-5148

Mailing address

3109 W Sycamore St
Kokomo, IN 46901-4181
Phone (765) 457-8381

Other identifiers 2

IdentifierTypeStateIssuer
000000183506OtherINBLUE CROSS BLUE SHIELD
200312000MedicaidIN

Other names 1

  • Ascension St. Vincent Kokomo Services Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040901000956 IN Part B Supplier - Clinic/Group Practice 5294700274 Receives reassigned benefits from 19 practitioners
1 other NPI on this enrollment
Practice locations: Kokomo, IN

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
St Joseph Primary LLC13 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

313 S Berkley Rd
Kokomo, IN 46901
Phone (765) 457-4673

Practitioners & affiliated clinicians

Practitioners 61

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 61

NPI Registry JSON

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

{
    "created_epoch": "1173657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708387200000",
    "number": "1982736377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3109 W SYCAMORE ST",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469014181",
            "telephone_number": "765-457-8381",
            "fax_number": "765-457-4443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1907 W SYCAMORE ST",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469015148",
            "telephone_number": "765-456-5433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOSEPH PRIMARY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-12",
        "last_updated": "2024-02-20",
        "certification_date": "2024-02-20",
        "status": "A",
        "authorized_official_last_name": "MORRIS",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "CFO (AMG)",
        "authorized_official_telephone_number": "317-338-6234"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "IN",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "742949291",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0008X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hepatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "000000183506",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200312000",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ascension St. Vincent Kokomo Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kokomo, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.