Individual provider Active NPI

Vilaas S. Shetty, M.D.

  • Diagnostic Radiology Physician
  • Saint Louis, MO
National Provider Identifier
1164577540
Registry record updated Apr 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
2007007109 Issued in MO
Practice address
615 S New Ballas Rd
Saint Louis, MO 63141-8221
Phone
(314) 251-6031
Fax
(314) 251-6343
NPI assigned
Jan 24, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2018

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

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 2004015892 MO
Body Imaging Physician 2085B0100X 2007007109 MO
Diagnostic Neuroimaging (Radiology) Physician 2085D0003X 2007007109 MO
Neuroradiology Physician 2085N0700X 20070071090 MO
Neuroradiology Physician 2085N0700X 2007007109 MO
Pediatric Radiology Physician 2085P0229X 2007007109 MO
Diagnostic Ultrasound Physician 2085U0001X 2008020890 MO
Diagnostic Radiology Physician 2085R0202X 2007007109 MO Primary

Addresses

Primary practice location

615 S New Ballas Rd
Saint Louis, MO 63141-8221

Mailing address

11475 Olde Cabin Rd Ste 200
Saint Louis, MO 63141-7129
Phone (314) 991-8200

Other practice location 1

901 E 5th St
Washington, MO 63090-3127
Phone (636) 239-8250

Other practice location 2

901 Patients First Dr
Washington, MO 63090-4700
Phone (636) 390-1575

Other identifiers 1

IdentifierTypeStateIssuer
209616804MedicaidMO

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
I20120626000572 MO Practitioner - Diagnostic Radiology 1557526522 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Texas Southwestern Medical School at Dallas, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
West County Radiological Group IncGroup PAC ID 8527966944, 105 clinicians

Practice addresses (Care Compare)

615 S New Ballas Rd
Saint Louis, MO 63141-8221
Phone (314) 251-6031

Hospital & facility affiliations

  • Mercy Hospital St Louis Hospital, Saint Louis, MO, CCN 260020
  • Mercy Hospital Washington Hospital, Washington, MO, CCN 260052
  • Mercy Hospital Jefferson Hospital, Crystal City, MO, CCN 260023
  • Mercy Hospital South Hospital, Saint Louis, MO, CCN 260077
  • Mercy Hospital Ardmore, Inc Hospital, Ardmore, OK, CCN 370047

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2004015892MOMDInternal Medicine Physician
2007007109MOMDBody Imaging Physician
20070071090MOMDNeuroradiology Physician
2008020890MOMDDiagnostic Ultrasound Physician

Practice roles

OrganizationSpecialtyStatusNew patients
SSM Cardinal Glennon Childrens Hospital Body Imaging CurrentSince Jul 1, 2012 Accepting new patients
West County Radiological Group, Inc. Neuroradiology CurrentSince Jan 29, 2018 Accepting new patients
SSM Health Care St. Louis Internal Medicine CurrentSince Jan 16, 2017 Accepting new patients
SSM Health Care St Louis CurrentSince Jan 16, 2017 Accepting new patients
SSM Cardinal Glennon Children'S Hospital CurrentSince Jul 1, 2012 Accepting new patients

Locations

7344 Solutions Ctr
Chicago, IL 60677
Phone (314) 989-6189

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

1015 Bowles Ave
Fenton, MO 63026
Phone (636) 496-2000

630 NW Englewood Rd
Kansas City, MO 64118
Phone (816) 453-2700

6420 Clayton Rd
Saint Louis, MO 63117
Phone (314) 768-8442

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

1465 S Grand Blvd
Saint Louis, MO 63104
Phone (314) 268-4070

701 S New Ballas Rd
Saint Louis, MO 63141
Phone (314) 251-6710

11475 Olde Cabin Rd
Ste 200
Saint Louis, MO 63141
Phone (314) 991-8200

1000 E Cherry St
Troy, MO 63379
Phone (636) 528-3327

901 Patients First Dr
Washington, MO 63090
Phone (636) 239-7500

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

430 N Monte Vista St
Ada, OK 74820
Phone (580) 226-1251

1011 14th Ave NW
Ardmore, OK 73401
Phone (580) 220-6658

3462 Hospital Rd
Healdton, OK 73438
Phone (580) 229-0701

300 Wanda St
Marietta, OK 73448
Phone (580) 276-2400

1000 S Byrd St
Tishomingo, OK 73460
Phone (580) 371-2327

Organizations & group practices 5

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 6

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": "1169596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524441600000",
    "number": "1164577540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11475 OLDE CABIN RD STE 200",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631417129",
            "telephone_number": "314-991-8200",
            "fax_number": "314-991-8206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 S NEW BALLAS RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418221",
            "telephone_number": "314-251-6031",
            "fax_number": "314-251-6343"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "901 E 5th St",
            "address_purpose": "LOCATION",
            "city": "Washington",
            "state": "MO",
            "postal_code": "630903127",
            "country_code": "US",
            "telephone_number": "636-239-8250",
            "fax_number": "636-239-8271",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "901 Patients First Dr",
            "address_purpose": "LOCATION",
            "city": "Washington",
            "state": "MO",
            "postal_code": "630904700",
            "country_code": "US",
            "telephone_number": "636-390-1575",
            "fax_number": "636-390-9710",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHETTY",
        "first_name": "VILAAS",
        "middle_name": "S.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-24",
        "last_updated": "2018-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2004015892",
            "primary": false
        },
        {
            "code": "2085B0100X",
            "taxonomy_group": "",
            "desc": "Radiology, Body Imaging",
            "state": "MO",
            "license": "2007007109",
            "primary": false
        },
        {
            "code": "2085D0003X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Neuroimaging",
            "state": "MO",
            "license": "2007007109",
            "primary": false
        },
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "MO",
            "license": "20070071090",
            "primary": false
        },
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "MO",
            "license": "2007007109",
            "primary": false
        },
        {
            "code": "2085P0229X",
            "taxonomy_group": "",
            "desc": "Radiology, Pediatric Radiology",
            "state": "MO",
            "license": "2007007109",
            "primary": false
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": "MO",
            "license": "2008020890",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MO",
            "license": "2007007109",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "209616804",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.