NPIMap

Individual provider Active NPI

Iqbal Amin, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • Saint Louis, MO
National Provider Identifier
1184619835
Registry record updated Jan 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
110953 Issued in MO
Practice address
12700 Southfork Rd
Suite 105
Saint Louis, MO 63128-3201
Phone
(318) 525-1866
Fax
(314) 525-1868
NPI assigned
Sep 19, 2005
Last updated
Jan 20, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 110953 MO Primary
Hospitalist Physician 208M00000X 110953 MO

Addresses

Primary practice location

12700 Southfork Rd
Suite 105
Saint Louis, MO 63128-3201

Mailing address

12700 Southfork Rd
Suite 105
Saint Louis, MO 63128-3201
Phone (318) 525-1866

Other identifiers 1

IdentifierTypeStateIssuer
204876908MedicaidMO

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
I20040422000676 MO Practitioner - Internal Medicine 1658367974 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

9 Sackston Woods LN
Creve Coeur, MO 63141-8228
Phone (877) 748-7030

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
39.17 of 100Reported as individual
Quality
25
Improvement activities
0
Cost
63.91

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
110953MOMDGeriatric Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mid-Town Medical Practice, LLC CurrentSince Jun 9, 2016 Accepting new patients
St. Anthony's Medical Center Current Accepting new patients
Inpatient Consultants of Missouri Inc Hospitalist Past Accepting new patients
Woodland Manor of Arnold LLC Past Accepting new patients
Beauvais Operator LLC Past Accepting new patients
Green Park Leasing Co., LLC Past Accepting new patients
Sage Nursing & Rehab LLC Past Accepting new patients
Flo-GP Leasing Co., LLC Past Accepting new patients
Chestnut Rehab and Nursing LLC Past Accepting new patients
Mercy Hospital South Past Accepting new patients
Blooming Oaks Wellness & Rehabilitation LLC PastSince Jul 30, 2024 Accepting new patients
Willowcreek Wellness & Rehabilitation LLC Past Accepting new patients
St. Sophia Healthcare, LLC Past Accepting new patients
Cori Manor Healthcare & Rehabilitation Center, LLC Past Accepting new patients
Ozarks Medical Center Past Accepting new patients
Maple Grove Wellness & Rehabilitation LLC Past Accepting new patients
Eldercare of the Valley, Inc Past Accepting new patients

Locations

102 N Main St
#3
Columbia, IL 62236

12700 Southfork Rd
Saint Louis, MO 63128
Phone (314) 543-5920

12700 Southfork Rd
Ste 105
Saint Louis, MO 63128
Phone (314) 525-1887

12700 Southfork Rd
Ste 175
Saint Louis, MO 63128
Phone (314) 525-1798

12700 Southfork Rd
Ste 2
Saint Louis, MO 63128
Phone (314) 525-4973

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

Ownership & related parties

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Stonebridge FlorissantFlorissant, MO, CCN 265365 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 1, 2008
Jan 1, 2008
Woodland Manor Nursing CenterArnold, MO, CCN 265324 Skilled nursing facility Contracted Managing Employee
Adp of the SNF		 Jul 1, 2019
Jan 3, 2025
St Sophia Health & Rehabilitation CenterFlorissant, MO, CCN 265120 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 May 4, 2017
Jan 8, 2026
Bluebird Wellness and RehabilitationSaint Louis, MO, CCN 265703 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jul 30, 2024
Jul 30, 2024
Willowcreek Wellness & RehabilitationFlorissant, MO, CCN 265607 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jul 30, 2024
Jul 30, 2024

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 17

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 17

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1127088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327017600000",
    "number": "1184619835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12700 SOUTHFORK RD",
            "address_2": "SUITE 105",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631283201",
            "telephone_number": "318-525-1866",
            "fax_number": "314-525-1868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12700 SOUTHFORK RD",
            "address_2": "SUITE 105",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631283201",
            "telephone_number": "318-525-1866",
            "fax_number": "314-525-1868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMIN",
        "first_name": "IQBAL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-19",
        "last_updated": "2012-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "MO",
            "license": "110953",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MO",
            "license": "110953",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "204876908",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.