Tracy M. Riordan, M.D.
Individual provider Active NPI Internal Medicine Physician · Imperial, MO
NPI 1124094362 · NPPES record last updated Sep 20, 2017
Key facts
- NPI
- 1124094362
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 2002013047 (MO)
- Practice address
- 1254 Main St
Imperial, MO 63052-3861 - Phone
- (636) 741-3130
- NPI assigned
- Feb 27, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 8
Hospital & facility affiliations 6
Owned or controlled facilities with NPI records 1
Medicare Care Compare profile
- Specialty
- Internal Medicine
- Education
- Saint Louis University School of Medicine, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Mercy Clinic East Communities
Practice addresses (Care Compare)
1254 Main St
Imperial, MO 63052-3861
Phone (636) 741-3130
Hospital & facility affiliations
- Mercy Home Health
- Mercy Hospital St Louis
- Mercy Hospital South
- Mercy Hospital Jefferson
- Barnes Jewish Hospital
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
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Mercy Hospital Jefferson |
Hospital | Corporate Director | Jul 1, 2019 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20031218000167 | MO | Practitioner - Internal Medicine | 5698672509 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercy Hospitals East Communities | Current |
Accepting new patients | |
| Mercy Hospitals East Communities | Current |
Accepting new patients | |
| Mercy Clinic East Communities | Internal Medicine | Current |
Accepting new patients |
Locations
1254 Main St
Imperial, MO 63052
Phone (636) 741-3130
615 S New Ballas Rd
Saint Louis, MO 63141
Phone (314) 251-4687
621 S New Ballas Rd
Ste 4017B
Saint Louis, MO 63141
Phone (314) 872-9192
621 S New Ballas Rd
Ste 189A
Saint Louis, MO 63141
Phone (314) 251-6335
621 S New Ballas Rd
Ste 3017B
Saint Louis, MO 63141
Phone (314) 251-6505
Interoperability endpoints
- triordan237@directc.mercy.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 2002013047 | MO | Yes |
Addresses
Primary practice location
1254 Main St
Imperial, MO 63052-3861
Mailing address
1254 Main Street
Imperial, MO 63052
Phone (636) 741-3130
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124094362 | Medicaid | MO |
Other providers in Imperial, MO
- Preventive Plus Inc
- Amy Raster
- Thea Renick
- Brooke Lauren Reynolds
- Ride on St Louis, Inc.
- Riversedge Psychological Services
- Celso Ferreira Rodrigues
- Emily Rodriguez
- Schmitz Chiropractic, LLC
- Gerald Charles Schmitz
All providers in Imperial, MO · 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 Sep 20, 2017. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- 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.