JACKIE L GROSKLOS (NPI# 1245223239) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245223239 |
| Entity Type | Individual |
| Full Name | JACKIE L GROSKLOS |
| Credential | MD |
| Practice Address |
450 N New Ballas Rd Ste 270 W Saint Louis MO 63195-2632 |
| Practice Telephone | 3149916969 |
| Practice Fax Number | 3149976969 |
| Mailing Telephone | 3149916969 |
| Mailing Fax Number | 3149976969 |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2016-01-19 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
R9H27 | MO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | MEDICARE PROVIDER ID | 003012762 | 01 |
| MO | RR MEDICARE NUMBER | 060049013 | 01 |
| MO | MEDICARE PROV ID AREA 99 | 002013185 | 01 |
| MO | RR GROUP 01 | CD6536 | 01 |
| Street Address |
450 N NEW BALLAS RD STE 270 W |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63195-2632 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639176860 | Mary Carolyn Gamache | Internal Medicine | 450 N New Ballas Rd, Suite 170, Saint Louis, MO 63141-6835 | 2005-07-01 |
| 1396107959 | Hhc Health Care, LLC | Internal Medicine | 450 N New Ballas Rd, Suite 202 South Wing, Saint Louis, MO 63141-6835 | 2016-03-23 |
| 1164824652 | Hhc Health Care, LLC | Internal Medicine | 450 N New Ballas Rd, Ste 270 West Wing, Saint Louis, MO 63141-6835 | 2014-09-16 |
| 1043612534 | Hhc Asc, LLC | Clinic/Center | 450 N New Ballas Rd, Ste. 206 South Wing, Saint Louis, MO 63141-6835 | 2014-09-16 |
| 1538468558 | Thomas J Smith | Nurse Anesthetist, Certified Registered | 450 N New Ballas Rd, Saint Louis, MO 63141-6835 | 2011-03-16 |
| 1942508023 | Pearl Imaging, LLC | Clinic/Center | 450 N New Ballas Rd, Suite 20-ll, Saint Louis, MO 63141-6835 | 2011-03-14 |
| 1902049877 | Heart Health Center Ambulatory Surgery Center. LLC | Clinic/Center | 450 N New Ballas Rd, Suite 110 South Wing, Saint Louis, MO 63141-6835 | 2009-04-08 |
| 1427219286 | Christopher Black | Anesthesiology | 450 N New Ballas Rd, Saint Louis, MO 63141-6835 | 2008-06-24 |
| 1396923694 | St. Luke's Whc, LLC | Radiology | 450 N New Ballas Rd, Suite 250, Saint Louis, MO 63141-6835 | 2008-02-08 |
| 1013130376 | Beth Anne Basler | Nurse Practitioner | 450 N New Ballas Rd, Suite 270, Saint Louis, MO 63141-6835 | 2007-04-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033326137 | Luke S Choi | Orthopaedic Surgery | 14285 N. Outer Forty Rd, Suite 200, Chesterfield, MO 63195-0000 | 2007-05-17 |
| 1831160761 | Anthony S Shen | Internal Medicine | 3009 N Ballas Rd Suite 315a, Saint Louis, MO 63195-2485 | 2006-01-30 |
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427315423 | Paul Larsen | Internal Medicine | 1027 Bellevue Ave Ste 200, Saint Louis, MO 63117-1851 | 2012-04-13 |
| 1275899718 | Bradley Carl Witbrodt | Internal Medicine | 3023 N Ballas Rd Ste 200, Saint Louis, MO 63131-2330 | 2012-04-10 |
| 1194004952 | Jad Raffoul | Internal Medicine | 1402 S Grand Blvd Fl 14, Saint Louis, MO 63104-1004 | 2011-08-11 |
| 1982999462 | Philip L Mar | Internal Medicine | 3635 Vista Ave Fl 15, Saint Louis, MO 63110-2539 | 2011-06-13 |
| 1255644191 | Rugheed Ghadban | Internal Medicine | 1402 S Grand Blvd Ste 260, Saint Louis, MO 63104-1004 | 2010-07-20 |
| 1962727404 | Tyson E Turner | Internal Medicine | 625 S New Ballas Rd Ste 2015, Saint Louis, MO 63141 | 2010-03-27 |
| 1649468786 | Midwest Cardiovascular, Inc. | Internal Medicine | 1031 Bellevue Ave Ste 200, Saint Louis, MO 63117-1856 | 2007-10-12 |
| 1124225347 | Pradeep Aaron Chandra | Internal Medicine | 11155 Dunn Rd Ste 304e, Saint Louis, MO 63136-6111 | 2007-06-29 |
| 1699856443 | Miguel Angel Paniagua | Internal Medicine | 12414 Lusher Rd, Saint Louis, MO 63138-1456 | 2006-10-18 |
| 1235147109 | Jerome D Cohen | Internal Medicine | 8138 Westmoreland Ave, Provider Enrollment, Saint Louis, MO 63105-3731 | 2006-08-04 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63195 |
Please comment or provide details below to improve the information on JACKIE L GROSKLOS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.