Active NPI
Elena Georgieva Ignatova, D.D.S
- Dentist
- Saint Louis, MO
National Provider Identifier
1093099830
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2011015329
- Practice address
- 5471 Dr Martin Luther King Dr
Saint Louis, MO 63112-4265 - Phone
- (314) 367-5820
- Fax
- (314) 367-6326
- NPI assigned
- Sep 28, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019.028859 | IL | |
| Dentist | 122300000X | 2011015329 | MO | Primary |
Addresses
Primary practice location
5471 Dr Martin Luther King Dr
Saint Louis, MO 63112-4265
Mailing address
5471 Dr Martin Luther King Dr
Saint Louis, MO 63112-4265
Phone (314) 367-5820
Medicare participation
Medicare enrollment files- 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: No
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2011015329 | MO | MD | Dentist |
| 019.028859 | IL | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Carestl Health | Current | Accepting new patients | |
| Carestl Health | Current | Accepting new patients |
Locations
5471 Martin Luther King Dr
Saint Louis, MO 63112
Phone 3143675820 ext. 2221
Interoperability endpoints
- elena.ignatova@cstl.eclinicaldirectplus.com
- https://fhir4.healow.com/fhir/r4/CFFBCD/Endpoint/CFFBCD
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.
-
- Federally Qualified Health Center (FQHC)
- Saint Louis, MO
- NPI 1376685529
-
- Federally Qualified Health Center (FQHC)
- Saint Louis, MO
- NPI 1649312570
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1346025600000",
"number": "1093099830",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5471 DR MARTIN LUTHER KING DR",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631124265",
"telephone_number": "314-367-5820",
"fax_number": "314-367-6326"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5471 DR MARTIN LUTHER KING DR",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631124265",
"telephone_number": "314-367-5820",
"fax_number": "314-367-6326"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IGNATOVA",
"first_name": "ELENA",
"middle_name": "GEORGIEVA",
"credential": "D.D.S",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-28",
"last_updated": "2012-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IL",
"license": "019.028859",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MO",
"license": "2011015329",
"primary": true
}
],
"identifiers": [],
"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 Aug 27, 2012; 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.