SSM HEALTH ST. MARY'S HOSPITAL - CENTRALIA – NPI #1710105192
Clinic/Center

SSM HEALTH ST. MARY'S HOSPITAL - CENTRALIA is an AHC clinic located in CENTRALIA, IL. NPPES has assigned the NPI number 1710105192 to SSM HEALTH ST. MARY'S HOSPITAL - CENTRALIA on April 23, 2007. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “SSM HEALTH ST. MARY'S HOSPITAL - CENTRALIA” is a dba name, the actual legal business name for this organization is ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS. The primary taxonomy selected by this provider is 261QR0401X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)

The NPI profile was previously updated about 3 years ago on Nov 27, 2023. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for SSM HEALTH ST. MARY'S HOSPITAL - CENTRALIA below.

NPI Profile for
ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS

NPI Number
1710105192
Enumeration Date

(more than 19 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS
Doing Business As (dba): SSM HEALTH ST. MARY'S HOSPITAL - CENTRALIA
Primary location
400 N PLEASANT AVE
CENTRALIA, IL 62801
Phone: (618) 436-8000 Fax:
Mailing address
PO BOX 503861
SAINT LOUIS, MO 63150-0001
Phone: (618) 436-8000 Fax:
Organization Subpart
No
Authorized Official
DAMON HARBISON
PRESIDENT
Phone: (618) 436-6205
Updated
Identifiers

Identifiers for SSM HEALTH ST. MARY'S HOSPITAL - CENTRALIA

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
otherBLUE CROSS BLUE SHIELDIL6123830
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QR0401X
- Clinic/Center / Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) (Primary)
IL 0002642

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.

Endpoint

Health Information Exchange (HEI)

HEI is the mobilization of health care information electronically across organizations within a region, community or hospital system. Endpoints provide a simple and secure way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the internet such as primary care physicians, specialists, hospitals, labs, etc.

Endpoint
https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service
Endpoint type
CONNECT URL
Endpoint Description
2.16.840.1.113883.3.1068.1
Content Type
Affiliation
Y
Endpoint Location
2720 DUNDEE RD # 302,
NORTHBROOK, IL 77025-1669