NPIMap

Individual provider Active NPI

Scott P Wasserstrom, MD

  • Internal Medicine Physician
  • Saint Louis, MO
National Provider Identifier
1184679961
Registry record updated Apr 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
108667 Issued in MO
Practice address
1110 Highlands Plaza Dr E
Ste 375
Saint Louis, MO 63110-1392
Phone
(314) 367-3113
Fax
(314) 454-9382
NPI assigned
May 23, 2006
Last updated
Apr 18, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2025

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 108667 MO Primary

Addresses

Primary practice location

1110 Highlands Plaza Dr E
Ste 375
Saint Louis, MO 63110-1392

Mailing address

PO Box 7412035
Chicago, IL 60674-2035
Phone (314) 367-3113

Other identifiers 1

IdentifierTypeStateIssuer
209809714MedicaidMO

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Washington University

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
I20050819000147 MO Practitioner - Internal Medicine 8820028830 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Washington University School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1110 Highlands Plaza Dr E
Suite 375
Saint Louis, MO 63110-1354
Phone (314) 367-3113

5701 Delmar Blvd
Saint Louis, MO 63112-2617
Phone (314) 367-7848

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Maryland Medical Group LTD Internal Medicine Current Accepting new patients
Washington University Clinical Associates - Maryland Medical CurrentSince Sep 1, 2014 Accepting new patients
SSM Health Care St. Louis Internal Medicine Past Accepting new patients

Locations

1110 Highlands Plaza Dr E
Ste 375
Saint Louis, MO 63110
Phone (314) 367-3113

Interoperability endpoints

  • Direct secure messaging: swasserstrom161629@direct.carenet.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744934400000",
    "number": "1184679961",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7412035",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606742035",
            "telephone_number": "314-367-3113",
            "fax_number": "314-454-9382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 HIGHLANDS PLAZA DR E",
            "address_2": "STE 375",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101392",
            "telephone_number": "314-367-3113",
            "fax_number": "314-454-9382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WASSERSTROM",
        "first_name": "SCOTT",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-23",
        "last_updated": "2025-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "108667",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "209809714",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "1110 Highlands Plaza Dr E",
            "address_2": "STE 375",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631101392",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.