Organization Active NPI

Cardiology & Critical Care Consultants Inc

  • Cardiovascular Disease Physician
  • Saint Louis, MO
National Provider Identifier
1003887175
Registry record updated Jan 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
R4A99 Issued in MO
Legal business name
CARDIOLOGY & CRITICAL CARE CONSULTANTS INC
Practice address
3915 Watson Rd
Suite 200
Saint Louis, MO 63109-1251
Phone
(314) 781-8082
NPI assigned
Jan 27, 2006
Last updated
Jan 20, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Randy Johnson, MD
Title
Delegated Official
Phone
(314) 781-8082

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X R4A99 MO Primary

Addresses

Primary practice location

3915 Watson Rd
Suite 200
Saint Louis, MO 63109-1251

Mailing address

1836 Lackland Hill Pkwy
Saint Louis, MO 63146-3572
Phone (314) 989-0300

Other identifiers 1

IdentifierTypeStateIssuer
502349004MedicaidMO

National Provider Directory

National Provider Directory

Locations

10004 Kennerly Rd
Ste 335
Saint Louis, MO 63128
Phone (314) 525-1497

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263945600000",
    "number": "1003887175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1836 LACKLAND HILL PKWY",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631463572",
            "telephone_number": "314-989-0300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3915 WATSON RD",
            "address_2": "SUITE 200",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631091251",
            "telephone_number": "314-781-8082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARDIOLOGY & CRITICAL CARE CONSULTANTS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-27",
        "last_updated": "2010-01-20",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "RANDY",
        "authorized_official_title_or_position": "DELEGATED OFFICIAL",
        "authorized_official_telephone_number": "314-781-8082",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MO",
            "license": "R4A99",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "502349004",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.