Individual provider Active NPI

Nathan Robertson, MD

  • Internal Medicine Physician
  • Saint Louis, MO
National Provider Identifier
1124439252
Registry record updated Nov 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2017013105 Issued in MO
Practice address
621 S New Ballas Rd Ste 112a
Saint Louis, MO 63141-8252
Phone
(314) 251-6339
Fax
(314) 251-4564
NPI assigned
May 12, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 2017013105 MO Primary

Addresses

Primary practice location

621 S New Ballas Rd Ste 112a
Saint Louis, MO 63141-8252

Mailing address

621 S New Ballas Rd Ste 112a
Saint Louis, MO 63141-8252
Phone (314) 251-6339

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
I20170615001038 MO Practitioner - Internal Medicine 2769784222 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Saint Louis University School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinic Adult Hospitalists - St. Louis, LLCGroup PAC ID 6002809944, 139 clinicians
Mercy Hospitals East CommunitiesGroup PAC ID 1658276811, 92 clinicians

Practice addresses (Care Compare)

615 S New Ballas Rd
Saint Louis, MO 63141-8221
Phone (314) 251-6339

Hospital & facility affiliations

  • Mercy Hospital St Louis Hospital, Saint Louis, MO, CCN 260020

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2017013105MOMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Hospital Lincoln Internal Medicine CurrentSince Oct 22, 2019 Accepting new patients
Mercy Clinic Adult Hospitalists - Washington, LLC CurrentSince Oct 22, 2019 Accepting new patients
Mercy Hospitals East Communities CurrentSince Jul 1, 2018 Accepting new patients
Mercy Hospitals East Communities CurrentSince Jul 1, 2018 Accepting new patients
St Anthonys Physician Organization Hospitalist Services, L.C. CurrentSince Oct 22, 2019 Accepting new patients
Mercy Clinic Adult Hospitalists- Jefferson, LLC Internal Medicine CurrentSince Oct 22, 2019 Accepting new patients
Mercy Clinic Adult Hospitalists - St. Louis, LLC Internal Medicine CurrentSince Jul 1, 2018 Accepting new patients
Mercy Hospitals East Communities Internal Medicine Past Accepting new patients

Locations

1400 US Highway 61
Crystal Cty, MO 63028
Phone (636) 933-1111

10010 Kennerly Rd
Saint Louis, MO 63128
Phone (314) 525-1328

615 S New Ballas Rd
#H
Saint Louis, MO 63141
Phone (314) 251-6075

615 S New Ballas Rd
Saint Louis, MO 63141
Phone (314) 251-4687

621 S New Ballas Rd
Ste 112A
Saint Louis, MO 63141
Phone (314) 251-6339

900 E Cherry St
Troy, MO 63379
Phone (636) 528-8585

901 E 5th St
Washington, MO 63090
Phone (636) 239-8000

Organizations & group practices 8

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 2

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": "1399852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637193600000",
    "number": "1124439252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 S NEW BALLAS RD STE 112A",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418252",
            "telephone_number": "314-251-6339",
            "fax_number": "314-251-4564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 S NEW BALLAS RD STE 112A",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418252",
            "telephone_number": "314-251-6339",
            "fax_number": "314-251-4564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "NATHAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-12",
        "last_updated": "2021-11-18",
        "certification_date": "2021-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2017013105",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.