MERCY CLINIC KIDS GI, LLC (NPI# 1033352885) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033352885 |
| Entity Type | Organization |
| Organization Name | MERCY CLINIC KIDS GI, LLC |
| Other Organization Name | ST. JOHN'S MERCY KIDS GI, LLC |
| Practice Address |
621 S New Ballas Rd Suite 140-a Saint Louis MO 63141-8232 |
| Mailing Address |
621 S New Ballas Rd Ste Y-g230 Saint Louis MO 63141-8232 |
| Practice Telephone | 3149960006 |
| Practice Fax Number | 3149960007 |
| Mailing Telephone | 3142515550 |
| Mailing Fax Number | 3142515552 |
| Enumeration Date | 2009-04-09 |
| Last Update Date | 2018-11-19 |
| Authorized Official Name | JOHN W. HUBERT (PRESIDENT) |
| Authorized Official Telephone | 3142151700 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | Y |
| Parent Organization Name | MERCY CLINIC EAST COMMUNITIES |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0206X |
Pediatrics Specialization: Pediatric Gastroenterology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 509292504 | 05 |
| Other Name | Type Code |
|---|---|
| St. John's Mercy Kids GI, LLC | Former Legal Business Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 211 Saint Francis Dr, Cape Girardeau, MO 637035049 | 3142515550 | 3142515552 |
| 4525 Mid Rivers Mall Dr Ste 10, Cottleville, MO 633762820 | 3142515550 | 3145215552 |
| Street Address |
621 S NEW BALLAS RD SUITE 140-A |
| 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 | 2080P0206X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Gastroenterology |
| A pediatrician who specializes in the diagnosis and treatment of diseases of the digestive systems of infants, children and adolescents. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using lighted scopes to see internal organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366920118 | Danielle Marie Kenner | Pediatrics | 615 S New Ballas Rd Ste Yg230, Saint Louis, MO 63141-8221 | 2018-08-03 |
| 1467747659 | Fernando Rafael Medina Carbonell | Pediatrics | 1465 S Grand Blvd, Saint Louis, MO 63104-1003 | 2011-06-15 |
| 1689986382 | Rachel Kassel | Pediatrics | 1 Childrens Pl # 3s34, Saint Louis, MO 63110-1002 | 2010-07-09 |
| 1508085382 | St Louis University | Pediatrics | 1465 S Grand Blvd, Saint Louis, MO 63104-1003 | 2007-04-24 |
| 1215954771 | Ross William Shepherd | Pediatrics | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2006-07-17 |
| 1528086048 | Phillip Irwin Tarr | Pediatrics | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2006-07-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003383258 | Jose J. Derdoy, Md, LLC | Pediatrics | 845 N New Ballas Ct Ste 330, Creve Coeur, MO 63141-7169 | 2018-10-25 |
| 1679699060 | Children's Gastroenterology of St. Louis, P.C. | Pediatrics | 224 S Woods Mill Rd Ste 640, Chesterfield, MO 63017-3451 | 2007-03-21 |
| 1366550261 | Jose Lorenzo Tirol Cocjin | Pediatrics | 2401 Gilham Rd Children's Mercy Hospitals and Clinic, Pediatric Gastroenterology, Kansas City, MO 64108 | 2006-08-29 |
| 1952361081 | David Richard Fleisher | Pediatrics | University of Missouri School of Medicine, Dept of Child Health. 1 Hospital Drive, Columbia, MO 65212 | 2006-03-24 |
| 1235510900 | Panamdeep Kaur | Pediatrics | 2401 Gillham Rd, Kansas City, MO 64108 | 2015-06-17 |
| 1194089557 | Roopali Mittal | Pediatrics | 404 N Keene St, Columbia, MO 65201 | 2012-06-30 |
| 1255622452 | Nadia Ibrahimi | Pediatrics | 2401 Gillham Rd, Kansas City, MO 64108-4619 | 2011-04-22 |
| 1356652606 | Abhishek Watts | Pediatrics | 1965 S Fremont Ave, Suite 220, Springfield, MO 65804-2201 | 2010-07-01 |
| 1346472461 | Daniel Raphael Levinson | Pediatrics | 1 Children's Place, St Louis, MO 63110-1002 | 2009-08-24 |
| 1952566994 | Valentina Shakhnovich | Pediatrics | 2401 Gillham Rd, Kansas City, MO 64108-4619 | 2008-07-18 |
| Find all providers with the same taxonomy | ||||
| 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.