Individual provider Active NPI

Olumide Ogunremi, MD

  • Internal Medicine Physician
  • Saint Louis, MO
National Provider Identifier
1114990074
Registry record updated Jun 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2001019983 Issued in MO
Practice address
11133 Dunn Rd
Saint Louis, MO 63136-6119
Phone
(314) 317-0600
Fax
(314) 317-0606
NPI assigned
Feb 10, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 2001019983 MO Primary
Hospitalist Physician 208M00000X 2001019983 MO

Addresses

Primary practice location

11133 Dunn Rd
Saint Louis, MO 63136-6119

Mailing address

12101 Woodcrest Executive Dr
Suite 210
Saint Louis, MO 63141-5047
Phone (314) 317-0600

Other identifiers 2

IdentifierTypeStateIssuer
205368202MedicaidMO
1114990074MedicaidIL

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100626000226 MO Practitioner - Internal Medicine 7618008269 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southeastern Physician Services PCGroup PAC ID 0042307852, 591 clinicians

Practice addresses (Care Compare)

11133 Dunn Rd
Saint Louis, MO 63136-6163
Phone (314) 653-4450

Hospital & facility affiliations

  • BJC Hospice Hospice, Saint Louis, MO, CCN 261511
  • Christian Hospital Northeast Hospital, Saint Louis, MO, CCN 260180
  • Barnes Jewish Hospital Hospital, Saint Louis, MO, CCN 260032

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2001019983MOMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hospital Medicine Services of Tennessee PC Internal Medicine CurrentSince Apr 26, 2020 Accepting new patients
Southeastern Physician Services PC Internal Medicine CurrentSince Jul 1, 2016 Accepting new patients
Christian Hospital Northeast- Northwest Past Accepting new patients

Locations

1432 Southwest Blvd
Jefferson Cty, MO 65109
Phone (573) 632-5560

6420 Clayton Rd
Saint Louis, MO 63117
Phone (314) 768-8442

11133 Dunn Rd
Saint Louis, MO 63136
Phone (314) 653-5000

10 Hospital Dr
Saint Peters, MO 63376
Phone (636) 394-2522

Interoperability endpoints

  • FHIR API: https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

Organizations & group practices 3

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 4

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": "1139529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403049600000",
    "number": "1114990074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12101 WOODCREST EXECUTIVE DR",
            "address_2": "SUITE 210",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631415047",
            "telephone_number": "314-317-0600",
            "fax_number": "314-317-0606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11133 DUNN RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631366119",
            "telephone_number": "314-317-0600",
            "fax_number": "314-317-0606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OGUNREMI",
        "first_name": "OLUMIDE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-10",
        "last_updated": "2014-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2001019983",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MO",
            "license": "2001019983",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "205368202",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1114990074",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.