Gateway Geriatric Services LLC

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

2005019644 Issued in MO

Legal business name

GATEWAY GERIATRIC SERVICES LLC

Practice address

12026 Conway Rd
Saint Louis, MO 63131-2417

Phone

(314) 225-6015

NPI assigned

May 5, 2011

Organization subpart

No

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

Authorized official

Name

Shailaja Pulisetty, M.D.NPI 1902014467

Title

Physician/President

Phone

(314) 225-6015

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shailaja Pulisetty, M.D.

  • Internal Medicine Physician
  • Saint Louis, MO
  • NPI 1902014467
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1304553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1310515200000",
    "number": "1114219417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12026 CONWAY RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631312417",
            "telephone_number": "314-225-6015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12026 CONWAY RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631312417",
            "telephone_number": "314-225-6015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GATEWAY GERIATRIC SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-05",
        "last_updated": "2011-07-13",
        "status": "A",
        "authorized_official_last_name": "PULISETTY",
        "authorized_official_first_name": "SHAILAJA",
        "authorized_official_title_or_position": "PHYSICIAN/PRESIDENT",
        "authorized_official_telephone_number": "314-225-6015",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "MO",
            "license": "2005019644",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Geriatric Medicine (Internal Medicine) Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Geriatric Medicine (Internal Medicine) Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2011; 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.