Active NPI
Fred G. Hicks, M.D.
- Psychiatry Physician
- Saint Louis, MO
National Provider Identifier
1043320427
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- R7D14
- Practice address
- 11477 Olde Cabin Rd
Suite 200
Saint Louis, MO 63141-7130 - Phone
- (314) 567-5000
- Fax
- (314) 567-3110
- NPI assigned
- Aug 30, 2006
- Last updated
- Oct 14, 2009
- 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | R7D14 | MO | Primary |
Addresses
Primary practice location
11477 Olde Cabin Rd
Suite 200
Saint Louis, MO 63141-7130
Mailing address
11477 Olde Cabin Rd
Suite 200
Saint Louis, MO 63141-7130
Phone (314) 567-5000
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100730 | Other | MO | HEALTHLINK |
| 1581541 | Other | MO | UNITED HEALTHCARE |
| 202118311 | Medicaid | MO | |
| 17058 | Other | MO | BLUE CROSS BLUE SHIELD |
| 260006282 | Other | MO | 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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1255478400000",
"number": "1043320427",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11477 OLDE CABIN RD",
"address_2": "SUITE 200",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631417130",
"telephone_number": "314-567-5000",
"fax_number": "314-567-3110"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11477 OLDE CABIN RD",
"address_2": "SUITE 200",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631417130",
"telephone_number": "314-567-5000",
"fax_number": "314-567-3110"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HICKS",
"first_name": "FRED",
"middle_name": "G.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-30",
"last_updated": "2009-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MO",
"license": "R7D14",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHLINK",
"identifier": "100730",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "1581541",
"state": "MO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "202118311",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "17058",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "260006282",
"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 Oct 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.