Individual provider Active NPI

Cheng Xin Jiang

  • Internal Medicine Physician
  • Saint Louis, MO
National Provider Identifier
1174043301
Registry record updated Nov 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2017018674 Issued in MO
Practice address
12700 Southfork Rd Ste 200
Saint Louis, MO 63128-3201
Phone
(314) 543-5942
Fax
(314) 543-5947
NPI assigned
Jun 20, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 2017018674 MO Primary

Addresses

Primary practice location

12700 Southfork Rd Ste 200
Saint Louis, MO 63128-3201

Mailing address

12700 Southfork Rd Ste 200
Saint Louis, MO 63128-3201
Phone (314) 543-5942

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
I20200716004024 MO Practitioner - Internal Medicine 1254607633 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Saint Louis University School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mercy Clinic East CommunitiesGroup PAC ID 7214827922, shared by 6 NPIs, 573 clinicians

Practice addresses (Care Compare)

1001 Cardwell St
Saint Clair, MO 63077-1094
Phone (636) 629-3300

12700 Southfork Rd
Suite 200
Saint Louis, MO 63128-3201
Phone (314) 543-5942

Hospital & facility affiliations

  • Mercy Home Health Home health agency, Saint Louis, MO, CCN 267253
  • Mercy Home Health Home health agency, Saint Louis, MO, CCN 267565
  • Mercy Hospital South Hospital, Saint Louis, MO, CCN 260077
  • Mercy Hospital St Louis Hospital, Saint Louis, MO, CCN 260020
  • Mercy Hospital Jefferson Hospital, Crystal City, MO, CCN 260023

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic East Communities Internal Medicine CurrentSince Jul 1, 2020 Accepting new patients
Mercy Clinic East Communities CurrentSince Jul 1, 2020 Accepting new patients
Mercy Clinic East Communities Internal Medicine CurrentSince Nov 8, 2023 Accepting new patients

Locations

1001 Cardwell St
Saint Clair, MO 63077
Phone (636) 629-3300

621 S New Ballas Rd
Ste 189A
Saint Louis, MO 63141
Phone (314) 251-6335

12700 Southfork Rd
Ste 200
Saint Louis, MO 63128
Phone (314) 525-4971

621 S New Ballas Rd
Ste 4017B
Saint Louis, MO 63141
Phone (314) 872-9192

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

851 E 5th St
Ste 328
Washington, MO 63090
Phone (636) 239-1101

Interoperability endpoints

  • Direct secure messaging: cjiang900235@directc.mercy.net

Organizations & group practices 3

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": "1497916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604275200000",
    "number": "1174043301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12700 SOUTHFORK RD STE 200",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631283201",
            "telephone_number": "314-543-5942",
            "fax_number": "314-543-5947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12700 SOUTHFORK RD STE 200",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631283201",
            "telephone_number": "314-543-5942",
            "fax_number": "314-543-5947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JIANG",
        "first_name": "CHENG XIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-20",
        "last_updated": "2020-11-02",
        "certification_date": "2020-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2017018674",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.