PHYSICIAN AFFILIATES OF ST. LUKE'S MEDICAL GROUP, LLC (NPI# 1013329150) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013329150 |
| Entity Type | Organization |
| Organization Name | PHYSICIAN AFFILIATES OF ST. LUKE'S MEDICAL GROUP, LLC |
| Practice Address |
121 Saint Lukes Center Dr Chesterfield MO 63017-3518 |
| Mailing Address |
121 Saint Lukes Center Dr Chesterfield MO 63017-3509 |
| Practice Telephone | 3145762475 |
| Mailing Telephone | 3145762490 |
| Mailing Fax Number | 3145762344 |
| Enumeration Date | 2014-05-23 |
| Last Update Date | 2018-03-17 |
| Authorized Official Name | RICK SONNE (EXEC DIRECTOR) |
| Authorized Official Telephone | 3145762490 |
| Is Organization Subpart | Y |
| Parent Organization Name | ST. LUKE'S MEDICAL GROUP |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians | ||
| Y | 208600000X | Surgery | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1 Meramec Bluffs Dr, Ballwin, MO 630213309 | 6368610600 |
| Street Address |
121 SAINT LUKES CENTER DR |
| City | CHESTERFIELD |
| State | MO |
| Zip Code | 63017-3518 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750387510 | James E Walentynowicz | Orthopaedic Surgery | 121 Saint Lukes Center Dr, Ste 302, Chesterfield, MO 63017-3509 | 2005-06-24 |
| 1679014146 | Palliative Care At St Lukes LLC | Internal Medicine | 121 Saint Lukes Center Dr, Chesterfield, MO 63017-3518 | 2017-03-16 |
| 1356889182 | Kaitlin Doneff | Registered Nurse | 121 Saint Lukes Center Dr, Suite 406, Chesterfield, MO 63017-3518 | 2017-01-31 |
| 1225586936 | Anita Detchemendy | Nurse Practitioner | 121 Saint Lukes Center Dr, Suite 506, Chesterfield, MO 63017-3518 | 2016-09-12 |
| 1306222518 | Chesterfield Valley Internal Medicine & Pediatrics LLC | Pediatrics | 121 Saint Lukes Center Dr, Attn: Rick Sonne, Chesterfield, MO 63017-3509 | 2015-08-11 |
| 1225446644 | Derrick Neuner | Specialist/Technologist | 121 Saint Lukes Center Dr, Chesterfield, MO 63017-3509 | 2014-07-29 |
| 1740697077 | Jamie Wilson | Nurse Practitioner | 121 Saint Lukes Center Dr, Suite 504, Chesterfield, MO 63017-3509 | 2014-07-18 |
| 1073930780 | Dianna Gaffner | Nurse Practitioner | 121 Saint Lukes Center Dr, Suite 406, Chesterfield, MO 63017-3509 | 2014-03-20 |
| 1053756296 | Heart Health Specialists, LLC | Internal Medicine | 121 Saint Lukes Center Dr, Ste 303, Chesterfield, MO 63017-3518 | 2013-05-01 |
| 1275875908 | Daniel Michael Marion | Internal Medicine | 121 Saint Lukes Center Dr, Suite 402, Chesterfield, MO 63017-3518 | 2013-03-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114549193 | Kathryn E Bos | Student in an Organized Health Care Education/Training Program | 873 Apt N Foxsprings Dr, Chesterfield, MO 63017 | 2020-05-12 |
| 1700415171 | Charles H. Edwards | Physical Therapist | 224 South Woods Millrd., Suite 610 South, Chesterfield, MO 63017 | 2020-04-07 |
| 1003454562 | Stephanie Henningsen | Physical Therapy Assistant | 307 S Woods Rd, Chesterfield, MO 63017 | 2019-12-16 |
| 1831746296 | Star Lynn Sutton | Occupational Therapy Assistant | 15207 Olive Boulevard, Chesterfield, MO 63017 | 2019-08-21 |
| 1639738438 | Van Amburg & Busiek Md's, LLC | Pharmacy | 232 S Woodsmill Road, Suite 330 East, Chesterfield, MO 63017 | 2019-06-06 |
| 1306306865 | Margaret Mary Wynn | Nurse Practitioner | 15740 South Outer Road, Chesterfield, MO 63017 | 2019-03-21 |
| 1205393089 | Kimberly Danielle | Nurse Practitioner | 744 Forest Trace Dr, Chesterfield, MO 63017 | 2019-02-27 |
| 1457823965 | Allison Joy Mcgrail | Dietitian, Registered | 45740 S Outer Forty Rd, Chesterfield, MO 63017 | 2018-12-21 |
| 1316418080 | Julie Lefere | Social Worker | Mercy Virtual Care Center, 15740 S Outer 40 Rd, Chesterfield, MO 63017 | 2018-12-06 |
| 1336629641 | Catherine Dolphin Smith | Nurse Practitioner | 224 S Woods Mill Rd Ste 500, Chesterfield, MO 63017 | 2018-08-16 |
| Find all providers in zip 63017 | ||||
| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740573658 | John T Porvaznik | Surgery | 15571 Clover Ridge Dr, Chesterfield, MO 63017-5232 | 2011-05-25 |
| 1164681615 | John Francis Donovan | Surgery | 24 Summerhill Ln, Chesterfield, MO 63017-8408 | 2008-06-09 |
| 1144223355 | Hannah-ngoc T Ha | Surgery | 226 S Woods Mill Rd, Suite 49w, Chesterfield, MO 63017-3662 | 2005-05-23 |
| 1144536830 | Vein Concepts, LLC. | Surgery | 6 Mcbride and Son Center Dr, Suite 201, Chesterfield, MO 63005-1418 | 2010-08-19 |
| 1891015632 | Breast Care Center At St. Luke's, LLC | Surgery | 232 S Woods Mill Rd, Ste 200 E, Chesterfield, MO 63017-3417 | 2010-06-03 |
| 1699934828 | Stephen Robert Broderick | Surgery | 222 S Woods Mill Rd, 550n, Chesterfield, MO 63017-3625 | 2008-06-03 |
| 1275739872 | Jeremy Earle Leidenfrost | Surgery | 222 S Woods Mill Rd, #550n, Chesterfield, MO 63017-3625 | 2007-06-21 |
| 1831235928 | William S Goldstein | Surgery | 6 Mcbride and Son Center Dr, Suite 201, Chesterfield, MO 63005-1418 | 2007-01-29 |
| 1093767238 | Patricia Ann Limpert | Surgery | 232 S Woods Mill Rd, Ste 200 East, Chesterfield, MO 63017-3417 | 2006-05-16 |
| 1790749968 | Harry O Cole | Surgery | 232 S Woods Mill Rd, Suite 400 East, Chesterfield, MO 63017-3417 | 2006-04-14 |
| Find all providers in CHESTERFIELD | ||||
| City | CHESTERFIELD |
| Zip Code | 63017 |
Please comment or provide details below to improve the information on PHYSICIAN AFFILIATES OF ST. LUKE'S MEDICAL GROUP, LLC.
| 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.