ST LOUIS UNIVERSITY (NPI# 1508085382) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508085382 |
| Entity Type | Organization |
| Organization Name | ST LOUIS UNIVERSITY |
| Other Organization Name | SLUCARE DEPT OF PEDIATRIC GASTROENTEROLOGY |
| Practice Address |
1465 S Grand Blvd Saint Louis MO 63104-1003 |
| Mailing Address |
1831 Chestnut St Ste 650 Saint Louis MO 63103-2236 |
| Practice Telephone | 3145775647 |
| Mailing Telephone | 3149776828 |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2019-06-21 |
| Authorized Official Name | ALYCE LANXON (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 3149776828 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0206X |
Pediatrics Specialization: Pediatric Gastroenterology |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| SLUCARE DEPT OF PEDIATRIC GASTROENTEROLOGY | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487869863 | St Louis University | Eyewear Supplier (Equipment, not the service) | 1755 South Grand, St Louis, MO 63104 | 2007-05-11 |
| 1194892463 | St Louis University | Orthopaedic Surgery | 1831 Chestnut St Ste 650, Saint Louis, MO 63103 | 2006-11-29 |
| 1093894842 | St Louis University | Internal Medicine | 10 Franklin, Washington, MO 63090 | 2006-11-03 |
| 1417035759 | St Louis University | Audiologist | 3750 Lindell, St Louis, MO 63108 | 2006-11-02 |
| 1992778237 | St Louis University | Urology | 3655 Vista Ave, Saint Louis, MO 63110-2539 | 2006-02-08 |
| 1164495412 | St Louis University | Pathology | 1402 South Grand, St Louis, MO 63104 | 2006-02-08 |
| 1801869136 | St Louis University | Psychiatry & Neurology | 1438 S Grand Blvd, Saint Louis, MO 63104-1027 | 2006-02-08 |
| 1740253095 | St Louis University | Dermatology | 1755 S Grand Blvd, Saint Louis, MO 63104-1540 | 2006-02-08 |
| 1184266413 | St Louis University | Pediatrics | 1465 S Grand Blvd, Saint Louis, MO 63104-1003 | 2019-10-08 |
| 1184908865 | St Louis University | Urology | 1465 S Grand Blvd, Saint Louis, MO 63104-1003 | 2011-09-29 |
| Street Address |
1465 S GRAND BLVD |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63104-1003 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528676921 | Gunjanpreet Kaur | Student in an Organized Health Care Education/Training Program | 1465 S Grand Blvd, Saint Louis, MO 63104-1003 | 2020-07-21 |
| 1972128510 | Millicent Rose Palacios | Nurse Practitioner | 1465 S Grand Blvd, Saint Louis, MO 63104-1003 | 2020-06-09 |
| 1083241863 | Nathaniel Joseph Conner | Student in an Organized Health Care Education/Training Program | 1465 S Grand Blvd, Saint Louis, MO 63104-1003 | 2020-03-24 |
| 1467089177 | Stacy Kollanur Mathews | Student in an Organized Health Care Education/Training Program | 1465 S Grand Blvd, Saint Louis, MO 63104-1003 | 2020-03-24 |
| 1568099299 | Susan Aye Mya Oo | Student in an Organized Health Care Education/Training Program | 1465 S Grand Blvd, Saint Louis, MO 63104-1003 | 2020-03-24 |
| 1861029514 | Gregory Joseph Weissler II | Student in an Organized Health Care Education/Training Program | 1465 S Grand Blvd, Saint Louis, MO 63104-1003 | 2020-03-24 |
| 1154958874 | Brendan Michael Mcenery | Student in an Organized Health Care Education/Training Program | 1465 S Grand Blvd, Saint Louis, MO 63104-1003 | 2020-03-24 |
| 1316574049 | Satvika Mikkilineni | Student in an Organized Health Care Education/Training Program | 1465 S Grand Blvd, Saint Louis, MO 63104-1003 | 2020-03-24 |
| 1972130607 | Katherine Letha Randolph | Student in an Organized Health Care Education/Training Program | 1465 S Grand Blvd, Saint Louis, MO 63104-1003 | 2020-03-24 |
| 1346877081 | Samuel Ryan Richey | Student in an Organized Health Care Education/Training Program | 1465 S Grand Blvd, Saint Louis, MO 63104-1003 | 2020-03-24 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407469570 | Family Care Health Centers | Clinic/Center | 2717 Sidney Street, St. Louis, MO 63104 | 2020-08-28 |
| 1023638038 | Laura Ann Humphrey | Physician Assistant | Allied Health Building 3437 Caroline Street, Room 3015, Saint Louis, MO 63104 | 2020-04-20 |
| 1174187264 | Ahsan Ali | Student in an Organized Health Care Education/Training Program | 1438 South Grand Blvd, Monteleone Hall, St. Louis, MO 63104 | 2019-04-24 |
| 1205359916 | Brenda Eve Ladin | Behavior Technician | 1221 Allen Market Lane Rear, St. Louis, MO 63104 | 2017-07-25 |
| 1841722063 | Gustavo G Mendez | Student in an Organized Health Care Education/Training Program | 1465 South Grand Bulevard Rm 2717, Ssm Health Cardinal Glennon Children's Hospital, Saint Louis, MO 63104 | 2017-03-28 |
| 1053776716 | Carmella Harper | Respiratory Therapist, Certified | 2678 Park Ave, St Louis, MO 63104 | 2015-12-23 |
| 1922485986 | Alexander Tremont | Internal Medicine | 1402 S Grand Blvd Rm M260, Saint Louis, MO 63104 | 2015-04-29 |
| 1306233341 | Healthcare R Us | Home Health | 2859 Sidney St, St Louis, MO 63104 | 2015-04-16 |
| 1396159091 | Daniela Hermelin | Pathology | 1402 South Grane, St. Louis, MO 63104 | 2014-06-20 |
| 1992117881 | Kelly Denise Durbin | Social Worker | 1920 S 7th St, Saint Louis, MO 63104 | 2014-05-27 |
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| 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 |
| 1033352885 | Mercy Clinic Kids Gi, LLC | Pediatrics | 621 S New Ballas Rd, Suite 140-a, Saint Louis, MO 63141-8232 | 2009-04-09 |
| 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 |
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| City | SAINT LOUIS |
| Zip Code | 63104 |
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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.