St. Joseph Primary Care, LLC
Organization Active NPI Family Medicine Physician · Kokomo, IN
NPI 1982736377 · NPPES record last updated Feb 20, 2024
Key facts
- NPI
- 1982736377
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 742949291 (IN)
- Legal business name
- ST. JOSEPH PRIMARY CARE, LLC
- Practice address
- 1907 W Sycamore St
Kokomo, IN 46901-5148 - Phone
- (765) 456-5433
- NPI assigned
- Mar 12, 2007
- Organization subpart
- No
Authorized official
- Name
- Brian Morris
- Title
- Cfo (Amg)
- Phone
- (317) 338-6234
Other NPIs on the same Medicare enrollment 1
Corporate family (same tax ID) 12
Practitioners 61
-
Lesley N Adibe, MD
-
Claude Merrill Ashby, M.D.
-
Melissa Anne Cogdell, CRNA
-
Linda J Zynger, MD
-
Jonathan Abraham Holmer, CRNA, MSN, RN
-
Heath Spence, MD
-
Alexander S Choi, MD
-
Danny L. Resser, D.O.
-
Susan Jo Kuhn, NP
-
David Williams, MD
-
Karam Abbasi, MD
-
David B Beeson, M.D.
-
Virginia Kay Delon, NURSE PRACTITIONER
-
Stuart Devaul, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Tax ID family
- St Joseph Primary LLC
Locations
313 S Berkley Rd
Kokomo, IN 46901
Phone (765) 457-4673
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 742949291 | IN | Yes |
| Internal Medicine Physician |
207R00000X | |||
| Gastroenterology Physician |
207RG0100X | |||
| Hepatology Physician |
207RI0008X | |||
| Pediatrics Physician |
208000000X | |||
| Pediatric Adolescent Medicine Physician |
2080A0000X | |||
| Urgent Care Clinic/Center | 261QU0200X | IN |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200312000 | Medicaid | IN | |
| 000000183506 | Other | IN | BLUE CROSS BLUE SHIELD |
Other names
- Ascension St. Vincent Kokomo Services
Other providers in Kokomo, IN
- St. Joseph Hospital & Health Center, Inc.
- St. Joseph Primary Care LLC
- St. Joseph Primary Care LLC
- St. Joseph Primary Care, LLC
- St. Joseph Primary Care, LLC
- St. Joseph Primary LLC
- St. Vincent Anderson Regional Hospital, Inc.
- St. Vincent Health Wellness and Preventive Care Institute, Inc.
- St. Vincent Health Wellness and Preventive Care Institute, Inc.
- St. Vincent Hospice - Anderson LLC
All providers in Kokomo, IN · Family Medicine Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 20, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.