Rajeshwar Peddi, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

2004011008 Issued in MO

Practice address

10010 Kennerly Rd
Saint Louis, MO 63128-2106

Phone

(314) 525-1000

Fax

(314) 617-0606

NPI assigned

Feb 10, 2006

Last updated

Oct 19, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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

• Jefferson Physician Network, LLC

  • Vascular Surgery Physician
  • Festus, MO
  • NPI 1558508606
  NPD (past)

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

{
    "created_epoch": "1139529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318982400000",
    "number": "1043283989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12125 WOODCREST EXECUTIVE DR",
            "address_2": "SUITE 220",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631415001",
            "telephone_number": "314-317-0600",
            "fax_number": "314-317-0606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10010 KENNERLY RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631282106",
            "telephone_number": "314-525-1000",
            "fax_number": "314-617-0606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDDI",
        "first_name": "RAJESHWAR",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-10",
        "last_updated": "2011-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2004011008",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MO",
            "license": "2004011008",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "209296011",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1043283989",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erin Pechacek
• Rebecca Davis Peck, M.D.
• Judy Susan Peckham, LPC
• Praveen Kelly Pedapudi
• Venkata Praneeth Peddada, DO
• Blake Edwin Pedersen, D.O.
• Peder Pedersen
• Rebecca Pederson
• Pediatric Behavior Specialists, LLC
• Pediatric Care for Kids

• Internal Medicine Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Internal Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.