NPIMap

Individual provider Active NPI

Kevin L Konzen, MD

  • Internal Medicine Physician
  • Saint Louis, MO
National Provider Identifier
1033102702
Registry record updated Apr 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
104494 Issued in MO
Practice address
4320 Forest Park Ave
Ste 1100
Saint Louis, MO 63108-2979
Phone
(314) 333-4100
Fax
(314) 333-4115
NPI assigned
Aug 26, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 104494 MO Primary

Addresses

Primary practice location

4320 Forest Park Ave
Ste 1100
Saint Louis, MO 63108-2979

Mailing address

PO Box 7412037
Chicago, IL 60674-2037
Phone (314) 333-4100

Other identifiers 1

IdentifierTypeStateIssuer
208096214MedicaidMO

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Washington University

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160914001596 MO Practitioner - Internal Medicine 3870588239 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Washington University Clinical Associates LLCGroup PAC ID 6002895893, 11 clinicians

Practice addresses (Care Compare)

4320 Forest Park Ave
Suite 1100
Saint Louis, MO 63108-2979
Phone (314) 333-4100

Hospital & facility affiliations

  • BJC Home Care Services Home health agency, Saint Louis, MO, CCN 267276
  • Amedisys Home Health of Missouri Home health agency, Hillsboro, MO, CCN 267270
  • Apollo Medical Home health agency, Saint Louis, MO, CCN 267580
  • Amedisys Home Health Home health agency, O Fallon, IL, CCN 148004
  • Anderson Home Health Services Home health agency, Maryville, IL, CCN 147420
  • Barnes Jewish Hospital Hospital, Saint Louis, MO, CCN 260032
  • Missouri Baptist Medical Center Hospital, Saint Louis, MO, CCN 260108
  • Memorial Hospital Hospital, Belleville, IL, CCN 140185
  • Barnes-Jewish West County Hospital Hospital, Creve Coeur, MO, CCN 260162
  • Alton Memorial Hospital Hospital, Alton, IL, CCN 140002
  • SSM Health Rehabilitation Hospital Inpatient rehabilitation facility, Richmond Heights, MO, CCN 263031

Merit-based Incentive Payment System (MIPS)

Final score
92.66 of 100Reported as group
Quality
100
Promoting interoperability
100
Improvement activities
40
Cost
75.54

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
104494MOMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Washington University Clinical Associates LLC CurrentSince Sep 1, 2016 Accepting new patients
Washington University CurrentSince Sep 1, 2016 Accepting new patients
Granite City Clinic Corp Past Accepting new patients
Granite City Clinic Corp Internal Medicine Past Accepting new patients

Locations

4320 Forest Park Ave
Ste 1100
Saint Louis, MO 63108
Phone (314) 333-4100

4921 Parkview Pl
Ste 13A
Saint Louis, MO 63110
Phone (314) 333-4100

4240 Duncan Ave
Ste 301
Saint Louis, MO 63110

Networks

  • IA HMO C-SNP
  • IA HMO
  • devoted network organization-2b183dd2-4e80-4977-80a6-4fdf0df4361d

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1125014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744848000000",
    "number": "1033102702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7412037",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606742037",
            "telephone_number": "314-333-4100",
            "fax_number": "314-333-4115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4320 FOREST PARK AVE",
            "address_2": "STE 1100",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631082979",
            "telephone_number": "314-333-4100",
            "fax_number": "314-333-4115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KONZEN",
        "first_name": "KEVIN",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-26",
        "last_updated": "2025-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "104494",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208096214",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "4320 Forest Park Ave",
            "address_2": "Ste 1100",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631082979",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.