Individual provider Active NPI

Elena Georgieva Ignatova, D.D.S

  • Dentist
  • Saint Louis, MO
National Provider Identifier
1093099830
Registry record updated Aug 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2011015329 Issued in MO
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

Updated by the provider on Aug 27, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160107000394 MO Practitioner - Oral Surgery 5395047435 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2011015329MOMDDentist
019.028859ILMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Carestl Health Current Accepting new patients
Carestl Health CurrentSince Nov 30, 2015 Accepting new patients

Locations

5471 Martin Luther King Dr
Saint Louis, MO 63112
Phone 3143675820 ext. 2221

Interoperability endpoints

  • Direct secure messaging: elena.ignatova@cstl.eclinicaldirectplus.com
  • FHIR API: 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.

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

Verify at the official NPI Registry.