NPIMap

Organization Active NPI

Renewed Health 180 LP

  • Family Medicine Physician
  • Creve Coeur, MO
National Provider Identifier
1164174439
Registry record updated Jan 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
RENEWED HEALTH 180 LP
Practice address
456 N New Ballas Rd Ste 101a
Creve Coeur, MO 63141-6831
Phone
(314) 866-9940
NPI assigned
Jan 19, 2022
Last updated
Jan 19, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2022

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

Authorized official

Name
Chandrachur BanerjeeNPI 1972666238
Title
Authorized Official
Phone
(314) 866-9940

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

456 N New Ballas Rd Ste 101a
Creve Coeur, MO 63141-6831

Mailing address

456 N New Ballas Rd Ste 101a
Creve Coeur, MO 63141-6831
Phone (314) 866-9940

National Provider Directory

National Provider Directory

Locations

456 N New Ballas Rd
Ste 101A
Creve Coeur, MO 63141
Phone (314) 866-9940

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1642550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642550400000",
    "number": "1164174439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "456 N NEW BALLAS RD STE 101A",
            "city": "CREVE COEUR",
            "state": "MO",
            "postal_code": "631416831",
            "telephone_number": "314-866-9940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "456 N NEW BALLAS RD STE 101A",
            "city": "CREVE COEUR",
            "state": "MO",
            "postal_code": "631416831",
            "telephone_number": "314-866-9940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENEWED HEALTH 180 LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-19",
        "last_updated": "2022-01-19",
        "certification_date": "2022-01-19",
        "status": "A",
        "authorized_official_last_name": "BANERJEE",
        "authorized_official_first_name": "CHANDRACHUR",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "314-866-9940"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Creve Coeur, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.