Active NPI
John David Wilkes, MD
- Hematology & Oncology Physician
- Lake St Louis, MO
National Provider Identifier
1023071347
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hematology & Oncology Physician
- License
- R7J99
- Practice address
- 400 Medical PLZ
Suite 100
Lake St Louis, MO 63367-1490 - Phone
- (636) 639-8600
- Fax
- (636) 639-8676
- NPI assigned
- Apr 8, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hematology & Oncology Physician | 207RH0003X | R7J99 | MO | Primary |
Addresses
Primary practice location
400 Medical PLZ
Suite 100
Lake St Louis, MO 63367-1490
Mailing address
500 Medical Drive
Wentzville, MO 63385
Phone (636) 327-1202
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 208002113 | Medicaid | MO | |
| 57015 | Other | GHP | |
| 273988 | Other | HEALTHLINK | |
| 4676254 | Other | AETNA | |
| 6198 | Other | MI | BCBS |
| 6198 | Other | BC | |
| 3609028 | Other | UHC | |
| 900002001 | Other | RR MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R7J99 | MO | MD | Hematology & Oncology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144454400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1347235200000",
"number": "1023071347",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 MEDICAL DRIVE",
"city": "WENTZVILLE",
"state": "MO",
"postal_code": "63385",
"telephone_number": "636-327-1202",
"fax_number": "636-327-1222"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 MEDICAL PLZ",
"address_2": "SUITE 100",
"city": "LAKE ST LOUIS",
"state": "MO",
"postal_code": "633671490",
"telephone_number": "636-639-8600",
"fax_number": "636-639-8676"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILKES",
"first_name": "JOHN",
"middle_name": "DAVID",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-08",
"last_updated": "2012-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "207RH0003X",
"taxonomy_group": "",
"desc": "Internal Medicine, Hematology & Oncology",
"state": "MO",
"license": "R7J99",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "208002113",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHP",
"identifier": "57015",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHLINK",
"identifier": "273988",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4676254",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "6198",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC",
"identifier": "6198",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UHC",
"identifier": "3609028",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "900002001",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake St Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.