St. Louis Nephrology and Hypertension

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

R9H62 Issued in MO

Legal business name

ST. LOUIS NEPHROLOGY AND HYPERTENSION

Practice address

2102 Vadalabene Dr
Maryville, IL 62062-5632

Phone

(618) 288-1196

NPI assigned

Nov 1, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Henry E Purcell, M.D.NPI 1467530410

Title

President

Phone

(314) 276-7664

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL, MO2 enrollments

Enrollment records 2

Locations

Practitioners 6

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

• Henry Purcell, M.D.

  • Nephrology Physician
  • Maryville, IL
  • NPI 1467530410

  MO

  Medicare reassignment NPD Authorized official
• Sriraj T. Kanungo, M.D.

  • Nephrology Physician
  • Maryville, IL
  • NPI 1548355621
  Medicare reassignment
• Kellee Ann Marshall, RD, LD

  • Registered Dietitian
  • O Fallon, IL
  • NPI 1679716476
  NPD (past)
• Tanya L Smith, RD

  • Registered Dietitian
  • Freeburg, IL
  • NPI 1720237084
  NPD (past)
• Rachel Ann Matusiak, M.S., R.D., L.D.

  • Registered Dietitian
  • Saint Louis, MO
  • NPI 1306075213
  NPD (past)
• Catherine Marie Wheeler, APRN BC ANP ACNP

  • Nurse Practitioner
  • Saint Louis, MO
  • NPI 1477653491
  NPD (past)

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725926400000",
    "number": "1174601124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 797021",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631797000",
            "telephone_number": "314-644-3535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2102 VADALABENE DR",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620625632",
            "telephone_number": "618-288-1196"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 Lanter Ct",
            "address_purpose": "LOCATION",
            "city": "Collinsville",
            "state": "IL",
            "postal_code": "622346124",
            "country_code": "US",
            "telephone_number": "618-344-2080",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9 American Vlg",
            "address_purpose": "LOCATION",
            "city": "Granite City",
            "state": "IL",
            "postal_code": "620403706",
            "country_code": "US",
            "telephone_number": "618-452-5858",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ST. LOUIS NEPHROLOGY AND HYPERTENSION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2024-09-10",
        "certification_date": "2024-09-10",
        "status": "A",
        "authorized_official_last_name": "PURCELL",
        "authorized_official_first_name": "HENRY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "314-276-7664",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "MO",
            "license": "R9H62",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DG8471",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southern Illinois Surgical Consultants S.C.
• Michael Southwick, CRNA
• Spinally Better, LLC
• SPS Surgical Services, SC
• SSM Medical Group
• Patrice Staten, M.D.
• Amy L Stein, OTR/L
• Thomas Troy Stewart, N.P.
• Sara Stratton, LCPC
• Konner Sloane Street, DPT

• Nephrology Physician in Maryville, IL
• Providers in Maryville, IL by specialty
• Nephrology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.