MISSOURI RENAL MEDICINE (NPI# 1427267855) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427267855 |
| Entity Type | Organization |
| Organization Name | MISSOURI RENAL MEDICINE |
| Practice Address |
621 S New Ballas Rd Suite 3015b Saint Louis MO 63141-8232 |
| Practice Telephone | 3142516344 |
| Practice Fax Number | 3142517929 |
| Mailing Telephone | 3142516344 |
| Mailing Fax Number | 3142517929 |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2012-05-03 |
| Authorized Official Name | ROBYN H JACOBS (PHYSICIAN) |
| Authorized Official Telephone | 3142516344 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RN0300X |
Internal Medicine Specialization: Nephrology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 506877000 | 05 | |
| MO | RAILROAD MEDICARE | CP8380 | 01 |
| Street Address |
621 S NEW BALLAS RD SUITE 3015B |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63141-8232 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790788941 | Robert J Backer | Specialist | 621 S New Ballas Rd, Ste 297a, Saint Louis, MO 63141-8232 | 2005-05-23 |
| 1609362474 | Manesh Kumar Gangwani | Internal Medicine | 621 S New Ballas Rd, Saint Louis, MO 63141-8232 | 2018-07-05 |
| 1164918165 | Ayesha Farrukh | Internal Medicine | 621 S New Ballas Rd, Saint Louis, MO 63141-8232 | 2018-07-03 |
| 1720573769 | Chelsea Renee Drissell | Family Medicine | 621 S New Ballas Rd, Saint Louis, MO 63141 | 2018-06-22 |
| 1023502358 | Bryan Gabriel Acree | Internal Medicine | 621 S New Ballas Rd, Saint Louis, MO 63141-8232 | 2018-06-20 |
| 1700370996 | Kathryn Emily Harvey-feldewerth | Internal Medicine | 621 S New Ballas Rd, Saint Louis, MO 63141-8232 | 2018-06-20 |
| 1063906493 | Paul Pearson Panasiuk | Obstetrics & Gynecology | 621 S New Ballas Rd, Saint Louis, MO 63141-8232 | 2018-06-19 |
| 1558855056 | Jessica Jenkins | Obstetrics & Gynecology | 621 S New Ballas Rd, Saint Louis, MO 63141-8232 | 2018-06-18 |
| 1679067276 | Kristopher Vaughn Pullam | Family Medicine | 621 S New Ballas Rd, Saint Louis, MO 63141-8232 | 2018-06-18 |
| 1932693629 | Lawrence Andrew Rudolf | Family Medicine | 621 S New Ballas Rd, Saint Louis, MO 63141-8232 | 2018-06-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679102842 | Noor Ramadan | Pharmacist | 628 North New Ballad Road, Suite A, Creve Coeur, MO 63141 | 2020-04-08 |
| 1497381206 | Washington University | Durable Medical Equipment & Medical Supplies | 1044 North Mason Road, Suite 110/210, St. Louis, MO 63141 | 2020-03-13 |
| 1154956498 | Ashleigh Clendenny | Physician Assistant | Mercy Hospital St. Louis, 615 S New Ballas Rd, St. Louis, MO 63141 | 2020-03-06 |
| 1801429410 | Emili Lou Haley | Registered Nurse | 650 Maryville Drive, St Louis, MO 63141 | 2020-02-21 |
| 1629553110 | Rebecca Kathleen Pike | Social Worker | West County Psychological Associates, 12125 Woodcrest Executive Drive #110, St. Louis, MO 63141 | 2018-10-01 |
| 1649756099 | River City Sedation Associates, LLC | Nurse Anesthetist, Certified Registered | 12855 N 40 Dr Ste 150, Saint Louis, MO 63141 | 2018-07-18 |
| 1205333952 | Ear Care and Hearing of St. Louis | Hearing Aid Equipment | 11630 Studt Ave Ste 210, Creve Coeur, MO 63141 | 2018-04-10 |
| 1659897486 | Erin Goodman | Physical Therapist | 10560 Old Olive St. Rd, Suite 100, Creve Coeur, MO 63141 | 2017-08-14 |
| 1093230450 | Center for Urologic Surgery LLC | Clinic/Center | 12855 N 40 Dr Ste 100, Saint Louis, MO 63141 | 2017-08-07 |
| 1871016105 | Jacob Farley Tanner | Specialist/Technologist | 1054 Town and Four Parkway Dr, Creve Coeur, MO 63141 | 2017-07-19 |
| Find all providers in zip 63141 | ||||
| Taxonomy Code | 207RN0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Nephrology |
| An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://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 |
|---|---|---|---|---|
| 1033649819 | Taewoo Lee | Internal Medicine | 3635 Vista Ave Saint Louis University Medical Center, Division of Nephrology, Saint Louis, MO 63110 | 2017-06-14 |
| 1780058727 | St Louis Kidney Care LLC | Internal Medicine | 11155 Dunn Rd Ste 211n, Saint Louis, MO 63136-6166 | 2015-11-13 |
| 1184056830 | Ralph Robert Hatlelid | Internal Medicine | 318 E Swon Ave, Saint Louis, MO 63119-3112 | 2013-08-05 |
| 1497000194 | Siddiq Anwar | Internal Medicine | 660 S Euclid Ave # 8129, Renal Fellowship Program, Saint Louis, MO 63110-1010 | 2012-07-18 |
| 1588764724 | Douglass Takashi Domoto | Internal Medicine | 2606 Clark Ave, Saint Louis, MO 63103-2502 | 2006-09-25 |
| 1699708016 | Bhajanlal S Dara | Internal Medicine | 10160 W Florissant Ave, Suite 200, Saint Louis, MO 63136-2104 | 2006-07-09 |
| 1962432807 | Guner Buyukkus Gulmen | Internal Medicine | 100 N Euclid Ave, Suite 800, Saint Louis, MO 63108-1529 | 2006-07-04 |
| 1710920947 | Rajalakshmi T Gopalakrishnan | Internal Medicine | 915, North Grand Boulevard, Saint Louis, MO 63106 | 2006-06-14 |
| 1457348286 | Kira S Mailey | Internal Medicine | 18 Chapel Hill Est, Saint Louis, MO 63131-1315 | 2005-10-06 |
| 1376166066 | Nhs South LLC | Internal Medicine | 10004 Kennerly Rd, Saint Louis, MO 63128-2141 | 2020-05-28 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63141 |
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| 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.