Active NPI
Family Medicine - SLMG South, LLC
- Family Medicine Physician
- Imperial, MO
National Provider Identifier
1164077822
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- FAMILY MEDICINE - SLMG SOUTH, LLC
- Practice address
- 1501 Professional Dr
Imperial, MO 63052-3809 - Phone
- (636) 464-4000
- Fax
- (636) 529-0699
- NPI assigned
- Aug 8, 2019
- Organization subpart
- Yes
- Parent organization
- ST. LUKES MEDICAL GROUP
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Darren R. Haskell, M.D.
- Title
- Chief Medical Officer
- Phone
- (314) 205-6444
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
1501 Professional Dr
Imperial, MO 63052-3809
Mailing address
121 Saint Lukes Center Dr
Chesterfield, MO 63017-3518
Phone (636) 685-7804
Other practice location 1
103 Hilltop Village Shopping Center Dr.
Eureka, MO 63025
Phone (636) 587-6350
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190925003479 | MO | Part B Supplier - Clinic/Group Practice | 3971833443 |
Receives reassigned benefits from 25 practitioners Practice locations: Arnold, MO; Eureka, MO; Imperial, MO |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 26D0437769 | Family Medicine-SLMG South, LLC | Certificate of waiver | Sep 28, 2027 |
National Provider Directory
National Provider Directory- Part of
- St Lukes Medical Group
Locations
874 Arnold Commons Dr
Arnold, MO 63010
Phone (314) 864-8596
103 Hilltop Village Center Dr
Eureka, MO 63025
Phone (314) 576-9797
1501 Professional Dr
Imperial, MO 63052
Phone (636) 464-4000
Ownership & related parties
Parent organization (reported in NPPES) 1
This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.
-
- Family Medicine Physician
- Chesterfield, MO
- NPI 1215308945
Practitioners & affiliated clinicians
Practitioners 25
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Medicine Physician
- Saint Clair, MO
- NPI 1093715096
Family Medicine, MO
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1565222400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1772668800000",
"number": "1164077822",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "121 SAINT LUKES CENTER DR",
"city": "CHESTERFIELD",
"state": "MO",
"postal_code": "630173518",
"telephone_number": "636-685-7804"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1501 PROFESSIONAL DR",
"city": "IMPERIAL",
"state": "MO",
"postal_code": "630523809",
"telephone_number": "636-464-4000",
"fax_number": "636-529-0699"
}
],
"practiceLocations": [
{
"address_1": "103 Hilltop Village Shopping Center Dr.",
"address_purpose": "LOCATION",
"city": "Eureka",
"state": "MO",
"postal_code": "63025",
"country_code": "US",
"telephone_number": "636-587-6350",
"fax_number": "636-529-0699",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "FAMILY MEDICINE - SLMG SOUTH, LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "ST. LUKES MEDICAL GROUP",
"enumeration_date": "2019-08-08",
"last_updated": "2026-03-05",
"certification_date": "2026-03-05",
"status": "A",
"authorized_official_last_name": "HASKELL",
"authorized_official_first_name": "DARREN",
"authorized_official_middle_name": "R.",
"authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
"authorized_official_telephone_number": "314-205-6444",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Imperial, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.