Organization Active NPI

Boris Khariton MD PC

  • Physical Medicine & Rehabilitation Physician
  • Saint Peters, MO
National Provider Identifier
1184847246
Registry record updated Jun 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
BORIS KHARITON MD PC
Practice address
70 Jungermann Cir Ste 302
Saint Peters, MO 63376-1637
Phone
(314) 667-5535
Fax
(314) 261-5010
NPI assigned
Apr 10, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2025

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

Authorized official

Name
Mrs. Joellen Hartzell
Title
Office Manager
Phone
(314) 667-5535

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208100000X Primary

Addresses

Primary practice location

70 Jungermann Cir Ste 302
Saint Peters, MO 63376-1637

Mailing address

PO Box 411091
Saint Louis, MO 63141-3091
Phone (314) 667-5535

Other identifiers 4

IdentifierTypeStateIssuer
P00621694 & DN4816OtherILRAILROAD MEDICARE OF ILLINOIS
607509141MedicaidIL
204975718MedicaidMO
250013745 & DN4815OtherMORAILROAD MEDICARE OF MISSOURI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070530000264 IL Part B Supplier - Clinic/Group Practice 3072610963 Receives reassigned benefits from 1 practitioner
Practice locations: Belleville, IL; Fairview Heights, IL
O20100525000949 MO Part B Supplier - Clinic/Group Practice 3072610963 Receives reassigned benefits from 1 practitioner
Practice locations: Chesterfield, MO; Saint Peters, MO; Saint Louis, MO

National Provider Directory

National Provider Directory

Locations

10 Crossroads Ct
Alton, IL 62002
Phone (618) 465-9960

200 W Homer M Adams Pkwy
Godfrey, IL 62035

6925 S Lindbergh Blvd
Ste A
Saint Louis, MO 63125
Phone (314) 894-8616

2821 N Ballas Rd
Ste C15
Saint Louis, MO 63131
Phone (314) 983-0088

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750204800000",
    "number": "1184847246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 411091",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631413091",
            "telephone_number": "314-667-5535",
            "fax_number": "314-261-5010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70 JUNGERMANN CIR STE 302",
            "city": "SAINT PETERS",
            "state": "MO",
            "postal_code": "633761637",
            "telephone_number": "314-667-5535",
            "fax_number": "314-261-5010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BORIS KHARITON MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-10",
        "last_updated": "2025-06-18",
        "certification_date": "2025-06-18",
        "status": "A",
        "authorized_official_last_name": "HARTZELL",
        "authorized_official_first_name": "JOELLEN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "314-667-5535",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE OF ILLINOIS",
            "identifier": "P00621694  & DN4816",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "607509141",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "204975718",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE OF MISSOURI",
            "identifier": "250013745 & DN4815",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Peters, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2025; 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.