NPIMap

Individual provider Active NPI

Keith Wickenhauser, MD

  • Internal Medicine Physician
  • Saint Charles, MO
National Provider Identifier
1184042855
Registry record updated Sep 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2018011071 Issued in MO
Practice address
711 Veterans Memorial Pkwy Ste 300
Saint Charles, MO 63303-2106
Phone
(636) 669-2350
NPI assigned
Mar 31, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X R3656 KY
Pediatrics Physician 208000000X 2018011071 MO
Internal Medicine Physician 207R00000X 2018011071 MO Primary

Addresses

Primary practice location

711 Veterans Memorial Pkwy Ste 300
Saint Charles, MO 63303-2106

Mailing address

PO Box 955534
Saint Louis, MO 63195-5534

Other practice location 1

550 S Jackson St
Suite A3K00
Louisville, KY 40202
Phone (502) 852-4277

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address kwickenhauser65703@direct-ehr-ssmhc.com Direct
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180718000317 MO Practitioner - Internal MedicinePractitioner - Pediatric Medicine 1355657065 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
Saint Louis University School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
SSM Medical Group IncGroup PAC ID 6608776299, 565 clinicians
Aging Well Health Care, LLCGroup PAC ID 1153232038, 236 clinicians

Practice addresses (Care Compare)

711 Veterans Memorial Pkwy
Suite 300
Saint Charles, MO 63303-2106
Phone (636) 669-2350

7212 Balson Ave
Saint Louis, MO 63130-3001

Hospital & facility affiliations

  • Premiere Home Health Home health agency, Saint Charles, MO, CCN 267612
  • SSM Health at Home Home Health-St. Louis Home health agency, Saint Louis, MO, CCN 267184
  • Aw Health Care Home health agency, Saint Louis, MO, CCN 267585
  • Vitas Healthcare Corporation Midwest Hospice, Saint Louis, MO, CCN 261616
  • St Croix Hospice Hospice, Saint Peters, MO, CCN 261633
  • SSM St Joseph Health Center Hospital, Saint Charles, MO, CCN 260005
  • Barnes-Jewish St Peters Hospital Hospital, Saint Peters, MO, CCN 260191
  • SSM St Joseph Hospital West Hospital, Lake Saint Louis, MO, CCN 260200
  • SSM Health Depaul Hospital St Louis Hospital, Bridgeton, MO, CCN 260104
  • Mercy Hospital St Louis Hospital, Saint Louis, MO, CCN 260020
  • SSM Health Rehabilitation Hospital Inpatient rehabilitation facility, Richmond Heights, MO, CCN 263031

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2018011071MOMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
SSM Medical Group, Inc. Internal Medicine CurrentSince Sep 1, 2024 Accepting new patients
SSM Medical Group Inc. CurrentSince Sep 1, 2024 Accepting new patients
SSM Health Care St. Louis Internal Medicine Past Accepting new patients

Locations

711 Veterans Memorial Pkwy
Ste 300
Saint Charles, MO 63303
Phone (636) 669-2215

1035 Bellevue Ave
Ste 500
Saint Louis, MO 63117
Phone (314) 647-1115

3555 Sunset Office Dr
Ste C100
Saint Louis, MO 63127
Phone (314) 238-9100

Interoperability endpoints

  • Direct secure messaging: kwickenhauser647270@direct.carenet.org
  • Direct secure messaging: kwickenhauser65703@direct-ehr-ssmhc.com

Organizations & group practices 4

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 12

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": "1396224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725321600000",
    "number": "1184042855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 955534",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631955534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 VETERANS MEMORIAL PKWY STE 300",
            "city": "SAINT CHARLES",
            "state": "MO",
            "postal_code": "633032106",
            "telephone_number": "636-669-2350"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "550 S Jackson St",
            "address_2": "Suite A3K00",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "40202",
            "country_code": "US",
            "telephone_number": "502-852-4277",
            "fax_number": "502-852-8980",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WICKENHAUSER",
        "first_name": "KEITH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-03-31",
        "last_updated": "2024-09-03",
        "certification_date": "2024-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KY",
            "license": "R3656",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2018011071",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2018011071",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kwickenhauser65703@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "kwickenhauser65703@direct-ehr-ssmhc.com",
            "address_1": "711 Veterans Memorial Pkwy Ste 300",
            "city": "Saint Charles",
            "state": "MO",
            "country_code": "US",
            "postal_code": "633032106",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "711 Veterans Memorial Pkwy Ste 300",
            "city": "Saint Charles",
            "state": "MO",
            "country_code": "US",
            "postal_code": "633032106",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Charles, MO

Sources for this page

Verify at the official NPI Registry.