NPIMap

Organization Active NPI

Interfaith Residence

  • Infectious Disease Physician
  • Saint Louis, MO
National Provider Identifier
1164235362
Registry record updated Dec 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
Legal business name
INTERFAITH RESIDENCE
Practice address
1101 N Jefferson Ave
Saint Louis, MO 63106-2222
Phone
(314) 535-1919
Fax
(314) 535-0909
NPI assigned
Jan 30, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2025

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

Authorized official

Name
Opal Jones
Title
President & Ceo
Phone
(314) 535-1919

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RI0200X Primary
Community Health Clinic/Center 261QC1500X
Primary Care Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP2300X

Addresses

Primary practice location

1101 N Jefferson Ave
Saint Louis, MO 63106-2222

Mailing address

1101 N Jefferson Ave
Saint Louis, MO 63106-2222
Phone (314) 535-1919

Other names 1

  • Key Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250721000677 MO Part B Supplier - Clinic/Group Practice 7012423700 Receives reassigned benefits from 7 practitioners
Practice locations: St Louis, MO

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D1087135Doorways Interfaith Residence1101 North Jefferson Avenue, Saint Louis, MO 63106Certificate of waiverJul 27, 2026

National Provider Directory

National Provider Directory
Tax ID family
Interfaith Residence2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1101 N Jefferson Ave
Saint Louis, MO 63106
Phone (314) 535-1919

1101 N Jefferson Ave
#B
Saint Louis, MO 63106
Phone (314) 417-1070

Practitioners & affiliated clinicians

Practitioners 8

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

NPI Registry JSON

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

{
    "created_epoch": "1738195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1766966400000",
    "number": "1164235362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 N JEFFERSON AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631062222",
            "telephone_number": "314-535-1919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 N JEFFERSON AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631062222",
            "telephone_number": "314-535-1919",
            "fax_number": "314-535-0909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERFAITH RESIDENCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-30",
        "last_updated": "2025-12-29",
        "certification_date": "2025-12-29",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "OPAL",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "314-535-1919"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Key Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2025; 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.

Verify at the official NPI Registry.