Individual provider Active NPI

Jareer Othman Baker Farah, MD

  • Interventional Cardiology Physician
  • Florissant, MO
National Provider Identifier
1073784583
Registry record updated Nov 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
2016038585 Issued in MO
Practice address
1225 Graham Rd Ste C-2310
Florissant, MO 63031-8023
Phone
(314) 953-6300
NPI assigned
Mar 13, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 2016038585 MO
Cardiovascular Disease Physician 207RC0000X 036142073 IL
Interventional Cardiology Physician 207RI0011X 036-142073 IL
Interventional Cardiology Physician 207RI0011X 2016038585 MO Primary

Addresses

Primary practice location

1225 Graham Rd Ste C-2310
Florissant, MO 63031-8023

Mailing address

1225 Graham Rd Ste C-2310
Florissant, MO 63031-8023
Phone (314) 953-6300

Other practice location 1

6810 State Route 162 Ste 102
Maryville, IL 62062-8560
Phone (618) 288-4076

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, IL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20170127001644 MO Practitioner - Interventional CardiologyPractitioner - Cardiovascular Disease (Cardiology) 6002977246 Reassigns benefits to 1 organization
I20170320001619 IL Practitioner - Interventional CardiologyPractitioner - Cardiovascular Disease (Cardiology) 6002977246 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Interventional CardiologyAlso: Cardiovascular Disease (Cardiology)
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fairview Heights Medical Group SCGroup PAC ID 6800784083, 448 clinicians

Practice addresses (Care Compare)

1 Memorial Dr
Alton, IL 62002-6722
Phone (618) 463-7240

1225 Graham Rd
Suite C 2310
Florissant, MO 63031-8023
Phone (314) 953-6300

1404 Cross St
Shiloh, IL 62269-2988
Phone (618) 607-3055

1418 Cross St
Suite 350
Shiloh, IL 62269-2988
Phone (618) 607-3900

2122 Troy Rd
Suite 130
Edwardsville, IL 62025-2540
Phone (618) 463-7600

Hospital & facility affiliations

  • Christian Hospital Northeast Hospital, Saint Louis, MO, CCN 260180
  • Anderson Hospital Hospital, Maryville, IL, CCN 140289
  • Memorial Hospital Hospital, Belleville, IL, CCN 140185
  • Barnes Jewish Hospital Hospital, Saint Louis, MO, CCN 260032
  • Alton Memorial Hospital Hospital, Alton, IL, CCN 140002

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting1-10
Pacemaker insertion or repair1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036142073ILMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Heights Medical Group SC CurrentSince Mar 1, 2017 Accepting new patients
Fairview Heights Medical Group SC CurrentSince Mar 1, 2017 Accepting new patients

Locations

1 Memorial Dr
Alton, IL 62002
Phone (618) 463-7240

6810 State Route 162
Ste 102
Maryville, IL 62062
Phone (618) 288-4076

1225 Graham Rd
Ste C-2310
Florissant, MO 63031
Phone (314) 953-6300

1225 Graham Rd
Ste C-1310
Florissant, MO 63031
Phone (314) 953-6300

11155 Dunn Rd
Ste 109N
Saint Louis, MO 63136
Phone (314) 837-3784

670 Mason Ridge Center Dr
Ste 300
Saint Louis, MO 63141
Phone (314) 953-8250

660 Mason Ridge Center Dr
Saint Louis, MO 63141
Phone (314) 273-6433

Interoperability endpoints

  • Direct secure messaging: jfarah11426@direct.carenet.org

Organizations & group practices 2

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 7

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": "1205366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637625600000",
    "number": "1073784583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1225 GRAHAM RD STE C-2310",
            "city": "FLORISSANT",
            "state": "MO",
            "postal_code": "630318023",
            "telephone_number": "314-953-6300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 GRAHAM RD STE C-2310",
            "city": "FLORISSANT",
            "state": "MO",
            "postal_code": "630318023",
            "telephone_number": "314-953-6300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6810 State Route 162 Ste 102",
            "address_purpose": "LOCATION",
            "city": "Maryville",
            "state": "IL",
            "postal_code": "620628560",
            "country_code": "US",
            "telephone_number": "618-288-4076",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FARAH",
        "first_name": "JAREER",
        "middle_name": "OTHMAN BAKER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-03-13",
        "last_updated": "2021-11-23",
        "certification_date": "2021-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MO",
            "license": "2016038585",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IL",
            "license": "036142073",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "IL",
            "license": "036-142073",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "MO",
            "license": "2016038585",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1225 Graham Rd Ste C-2310",
            "city": "Florissant",
            "state": "MO",
            "country_code": "US",
            "postal_code": "630318023",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Florissant, MO

Sources for this page

Verify at the official NPI Registry.