NPIMap

Organization Active NPI

Serenity Health LLC

  • Psychiatry Physician
  • Saint Peters, MO
National Provider Identifier
1104569151
Registry record updated Nov 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
SERENITY HEALTH LLC
Practice address
4905 Mexico Rd Ste 400
Saint Peters, MO 63376-1601
Phone
(314) 590-3721
Fax
(314) 214-7380
NPI assigned
Apr 18, 2022
Last updated
Nov 19, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2022

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

Authorized official

Name
Mr. Tariq F Malik
Title
Cfo
Phone
(314) 862-4840

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

4905 Mexico Rd Ste 400
Saint Peters, MO 63376-1601

Mailing address

4905 Mexico Rd Ste 400
Saint Peters, MO 63376-1601
Phone (314) 503-6330

Other practice location 1

5000 Cedar Plaza Pkwy Ste 300
Saint Louis, MO 63128-3891
Phone (314) 590-3721

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220523002493 MO Part B Supplier - Clinic/Group Practice 3375920861 Receives reassigned benefits from 47 practitioners
Practice locations: De Soto, MO; Saint Peters, MO; Saint Louis, MO; Osage Beach, MO; Chesterfield, MO

National Provider Directory

National Provider Directory

Locations

5000 Cedar Plaza Pkwy
Ste 220
Saint Louis, MO 63128
Phone (314) 378-3111

5000 Cedar Plaza Pkwy
Ste 220A
Saint Louis, MO 63128

4905 Mexico Rd
Ste 300
Saint Peters, MO 63376
Phone (636) 928-5109

4905 Mexico Rd
Ste 400
Saint Peters, MO 63376
Phone 31459037210

Practitioners & affiliated clinicians

Practitioners 60

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 60

NPI Registry JSON

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

{
    "created_epoch": "1650240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668816000000",
    "number": "1104569151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4905 MEXICO RD STE 400",
            "city": "SAINT PETERS",
            "state": "MO",
            "postal_code": "633761601",
            "telephone_number": "314-503-6330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4905 MEXICO RD STE 400",
            "city": "SAINT PETERS",
            "state": "MO",
            "postal_code": "633761601",
            "telephone_number": "314-590-3721",
            "fax_number": "314-214-7380"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5000 Cedar Plaza Pkwy Ste 300",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631283891",
            "country_code": "US",
            "telephone_number": "314-590-3721",
            "fax_number": "314-214-7380",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SERENITY HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-18",
        "last_updated": "2022-11-19",
        "certification_date": "2022-11-19",
        "status": "A",
        "authorized_official_last_name": "MALIK",
        "authorized_official_first_name": "TARIQ",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "314-862-4840",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Peters, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.