South County Endocrinology and Obesity Medicine LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

License

2001005643 Issued in MO

Legal business name

SOUTH COUNTY ENDOCRINOLOGY AND OBESITY MEDICINE LLC

Practice address

12900 Tesson Ferry Rd Ste 101
Saint Louis, MO 63128-3002

Phone

(314) 843-4848

Fax

(866) 510-2730

NPI assigned

Nov 15, 2012

Organization subpart

No

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

Authorized official

Name

Bharathi RajuNPI 1720078843

Title

Sole Member

Phone

(636) 236-5820

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Practitioners 4

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

• Bharathi Raju, MD

  • Endocrinology, Diabetes & Metabolism Physician
  • Saint Louis, MO
  • NPI 1720078843
  Medicare reassignment Care Compare group NPD Authorized official
• Edwin Joshua Crosier, PA-C

  • Surgical Physician Assistant
  • Saint Louis, MO
  • NPI 1447559752
  Medicare reassignment Care Compare group
• Alexa Evie Naceanceno, PA

  • Physician Assistant
  • Saint Louis, MO
  • NPI 1952867731
  Medicare reassignment Care Compare group
• Kathleen Honick, NP

  • Nurse Practitioner
  • Saint Peters, MO
  • NPI 1427478478
  NPD

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

{
    "created_epoch": "1352937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719792000000",
    "number": "1144564196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12900 TESSON FERRY RD STE 101",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631283002",
            "telephone_number": "314-843-4848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12900 TESSON FERRY RD STE 101",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631283002",
            "telephone_number": "314-843-4848",
            "fax_number": "866-510-2730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH COUNTY ENDOCRINOLOGY AND OBESITY MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-15",
        "last_updated": "2024-07-01",
        "certification_date": "2024-07-01",
        "status": "A",
        "authorized_official_last_name": "RAJU",
        "authorized_official_first_name": "BHARATHI",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "636-236-5820"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "MO",
            "license": "2001005643",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• South City Health LLC
• South City Hearing & Audiology, LLC
• South County Anesthesia Associates, LTD.
• South County Comprehensive Care LLC
• South County Dental Imaging Center
• South County Eye Care
• South County Family Dental, Inc
• South County Imaging Center LLC
• South County Internal Medicine Inc.
• South County Orthopedics and Sports Medicine Inc

• Multi-Specialty Clinic/Center in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Multi-Specialty Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2024; 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.