NPIMap

Individual provider Active NPI

Marc D Radabaugh, MD

  • Family Medicine Physician
  • Richmond Heights, MO
National Provider Identifier
1104358670
Registry record updated Aug 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2021034961 Issued in MO
Practice address
1027 Bellevue Ave Ste 107
Richmond Heights, MO 63117-1851
Phone
(314) 645-3743
Fax
(314) 647-7967
NPI assigned
Apr 3, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 11019421A IN
Internal Medicine Physician 207R00000X 2021034961 MO
Internal Medicine Physician 207R00000X 11019421A IN
Family Medicine Physician 207Q00000X 2021034961 MO Primary

Addresses

Primary practice location

1027 Bellevue Ave Ste 107
Richmond Heights, MO 63117-1851

Mailing address

PO Box 23340
Saint Louis, MO 63156-3340
Phone (314) 851-1000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210823001603 MO Practitioner - Family Practice 4789953456 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Louisville School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
American Multispecialty Group IncGroup PAC ID 1658365572, 118 clinicians

Practice addresses (Care Compare)

1027 Bellevue Ave
Suite 107
Saint Louis, MO 63117-1851
Phone (314) 645-3743

Hospital & facility affiliations

  • Aw Health Care Home health agency, Saint Louis, MO, CCN 267585
  • SSM Health St Mary'S Hospital - St Louis Hospital, Saint Louis, MO, CCN 260091
  • Mercy Hospital St Louis Hospital, Saint Louis, MO, CCN 260020
  • Missouri Baptist Medical Center Hospital, Saint Louis, MO, CCN 260108
  • St Lukes Hospital Hospital, Chesterfield, MO, CCN 260179
  • SSM Health Rehabilitation Hospital Inpatient rehabilitation facility, Richmond Heights, MO, CCN 263031

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11019421AINMDFamily Medicine Physician
2021034961MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
American Multispecialty Group Inc. Family Medicine CurrentSince Oct 1, 2021 Accepting new patients
Major Hospital Past Accepting new patients

Locations

1475 Kisker Rd
Ste 230
Saint Charles, MO 63304
Phone (636) 939-5000

1027 Bellevue Ave
Ste 107
Saint Louis, MO 63117
Phone (314) 645-3743

9930 Watson Rd
Saint Louis, MO 63126
Phone (314) 984-8827

Interoperability endpoints

  • Direct secure messaging: marc.radabaugh.p1@direct.essehealth.nextgenshare.com

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 8

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": "1491177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630281600000",
    "number": "1104358670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23340",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631563340",
            "telephone_number": "314-851-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1027 BELLEVUE AVE STE 107",
            "city": "RICHMOND HEIGHTS",
            "state": "MO",
            "postal_code": "631171851",
            "telephone_number": "314-645-3743",
            "fax_number": "314-647-7967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RADABAUGH",
        "first_name": "MARC",
        "middle_name": "D",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-03",
        "last_updated": "2021-08-30",
        "certification_date": "2021-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "11019421A",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2021034961",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "11019421A",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2021034961",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Richmond Heights, MO

Sources for this page

Verify at the official NPI Registry.