Rafi Thomas Kevorkian, MD
Individual provider Active NPI Geriatric Medicine (Internal Medicine) Physician · Saint Louis, MO
NPI 1124073630 · NPPES record last updated Oct 14, 2015
Key facts
- NPI
- 1124073630
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Geriatric Medicine (Internal Medicine) Physician 207RG0300X
- License
- 108134 (MO)
- Practice address
- 522 N New Ballas Rd Ste 317
Saint Louis, MO 63141-6840 - Phone
- (636) 634-5865
- Fax
- (636) 688-8317
- NPI assigned
- May 23, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Hospital & facility affiliations 8
Medicare Care Compare profile
- Specialty
- Geriatric Medicine
- Education
- Saint Louis University School of Medicine, 1995
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Aging Well Health Care, LLC
Practice addresses (Care Compare)
7212 Balson Ave
Saint Louis, MO 63130-3001
Hospital & facility affiliations
- Aw Health Care
- Premiere Home Health
- Three Oaks Hospice
- BJC Hospice
- Gentiva
- Suncrest Hospice of St Louis, LLC
- Pathways Hospice and Palliative Care
- Missouri Baptist Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040112000343 | MO | Practitioner - Geriatric Medicine | 3274433560 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dr Rafi Kevorkian LLC | Geriatric Medicine | Current |
Accepting new patients |
| Pamella S Gronemeyer | Past | Accepting new patients |
Locations
522 N New Ballas Rd
Ste 317
Saint Louis, MO 63141
Phone (314) 991-5365
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Medicine (Internal Medicine) Physician | 207RG0300X | 108134 | MO | Yes |
Addresses
Primary practice location
522 N New Ballas Rd Ste 317
Saint Louis, MO 63141-6840
Mailing address
522 N New Ballas Rd Ste 317
Saint Louis, MO 63141-6840
Phone (636) 634-5865
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00413101 | Other | MO | RR MEDICARE |
| 205037823 | Medicaid | MO |
NPI Registry JSON
{
"created_epoch": "1148342400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1444780800000",
"number": "1124073630",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "522 N NEW BALLAS RD STE 317",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631416840",
"telephone_number": "636-634-5865"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "522 N NEW BALLAS RD STE 317",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631416840",
"telephone_number": "636-634-5865",
"fax_number": "636-688-8317"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEVORKIAN",
"first_name": "RAFI",
"middle_name": "THOMAS",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-23",
"last_updated": "2015-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Geriatric Medicine",
"state": "MO",
"license": "108134",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "P00413101",
"state": "MO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "205037823",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
- Tish S. Kettler
- Ingrid Marie Kettmann
- John Ketzner
- Jason David Keune
- Jennifer Keutzer
- Kathlyn Kew
- Carrie Key
- Celeste Key
- Christopher Corteze Key
- Nina Key
All providers in Saint Louis, MO · Geriatric Medicine (Internal Medicine) Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 14, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.