Kian Pourak

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

2024018873 Issued in MO

Practice address

1 Barnes Jew Hosp PLZ
Saint Louis, MO 63110-1003

Phone

(314) 362-7388

NPI assigned

Mar 3, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1677801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718323200000",
    "number": "1053011676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4921 PARKVIEW PL # 6G",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 BARNES JEW HOSP PLZ",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101003",
            "telephone_number": "314-362-7388"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1500 E Medical Center Dr",
            "address_purpose": "LOCATION",
            "city": "Ann Arbor",
            "state": "MI",
            "postal_code": "481095000",
            "country_code": "US",
            "telephone_number": "734-936-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POURAK",
        "first_name": "KIAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-03-03",
        "last_updated": "2024-06-14",
        "certification_date": "2024-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MO",
            "license": "2024018873",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa G Potts, AUD
• Mary Anne Potts, PLPC
• Sharon Michelle Potts, COTA
• Timothy William Potts
• Catherine J Potzman, LCSW
• Pouredout Dental Group LLC
• James Mark Pousson, M.S.W., L.C.S.W.
• Gillian M Powderly, PHARM.D.
• Julie A Powderly, DPT
• William G Powderly, MD

• Student in an Organized Health Care Education/Training Program in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Student in an Organized Health Care Education/Training Program in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2024; 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.