NPIMap

Individual provider Active NPI

George Mansour, MD

  • Internal Medicine Physician
  • Saint Louis, MO
National Provider Identifier
1194072835
Registry record updated Apr 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2015021633 Issued in MO
Practice address
11040 Sandistan Dr
Saint Louis, MO 63146-5583
Phone
(402) 208-2254
NPI assigned
Aug 13, 2012
Last updated
Apr 18, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2023

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 2015021633 MO Primary

Addresses

Primary practice location

11040 Sandistan Dr
Saint Louis, MO 63146-5583

Mailing address

11040 Sandistan Dr
Saint Louis, MO 63146-5583
Phone (402) 208-2254

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
I20150714002939 MO Practitioner - Internal MedicinePractitioner - Hospitalist 6406169846 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Hospitalist
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aging Well Health Care, LLCGroup PAC ID 1153232038, 236 clinicians

Practice addresses (Care Compare)

7212 Balson Ave
Saint Louis, MO 63130-3001

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Galen Inpatient Physicians PC Hospitalist CurrentSince Nov 26, 2019 Accepting new patients
Galen Inpatient Physicians PC. Internal Medicine CurrentSince Nov 26, 2019 Accepting new patients
GM Health LLC Internal Medicine CurrentSince Mar 20, 2023 Accepting new patients
Barnes Jewish St Peters Hospital Inc Past Accepting new patients
Florissant Skilled Nursing, LLC Past Accepting new patients
Beauvais Operator LLC Past Accepting new patients
Suncrest Hospice St Louis, LLC PastSince May 1, 2025 Accepting new patients
Christian Hospital Northeast- Northwest Past Accepting new patients

Locations

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 900-3125

1015 Bowles Ave
Fenton, MO 63026
Phone (636) 496-2000

Interoperability endpoints

  • Direct secure messaging: gmansour203481@direct-ehr-ssmhc.com
  • FHIR API: https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

Ownership & related parties

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Suncrest Hospice St Louis, LLCDes Peres, MO, CCN 261717 Hospice Contracted Managing Employee May 1, 2025

Owned or controlled facilities with NPI records 1

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

Organizations & group practices 10

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 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1344816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681776000000",
    "number": "1194072835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11040 SANDISTAN DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631465583",
            "telephone_number": "402-208-2254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11040 SANDISTAN DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631465583",
            "telephone_number": "402-208-2254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANSOUR",
        "first_name": "GEORGE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-08-13",
        "last_updated": "2023-04-18",
        "certification_date": "2023-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2015021633",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.