NPIMap

Organization Active NPI

Affton Medical Clinic

  • Pediatric Adolescent Medicine Physician
  • Saint Louis, MO
National Provider Identifier
1114048154
Registry record updated Jun 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
License
R5P40 Issued in MO
Legal business name
AFFTON MEDICAL CLINIC
Practice address
59 Grasso PLZ
Saint Louis, MO 63123-3107
Phone
(314) 638-9309
Fax
(314) 638-9333
NPI assigned
Apr 3, 2007
Last updated
Jun 16, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2008

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

Authorized official

Name
Dr. Rubilinda Gimena Casino, MD
Title
Medical Director
Phone
(314) 638-9309

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine Physician 2080A0000X R5P40 MO Primary

Addresses

Primary practice location

59 Grasso PLZ
Saint Louis, MO 63123-3107

Mailing address

59 Grasso PLZ
Saint Louis, MO 63123-3107
Phone (314) 638-9309

Other identifiers 1

IdentifierTypeStateIssuer
205357908MedicaidMO

National Provider Directory

National Provider Directory
Tax ID family
Affton Medical Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213574400000",
    "number": "1114048154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "59 GRASSO PLZ",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631233107",
            "telephone_number": "314-638-9309",
            "fax_number": "314-638-9333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "59 GRASSO PLZ",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631233107",
            "telephone_number": "314-638-9309",
            "fax_number": "314-638-9333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AFFTON MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-03",
        "last_updated": "2008-06-16",
        "status": "A",
        "authorized_official_last_name": "CASINO",
        "authorized_official_first_name": "RUBILINDA",
        "authorized_official_middle_name": "GIMENA",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "314-638-9309",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "MO",
            "license": "R5P40",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "205357908",
            "state": "MO"
        }
    ],
    "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 Jun 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.