NPIMap

Individual provider Active NPI

Russell KL Won, M.D.

  • General Practice Physician
  • Saint Louis, MO
National Provider Identifier
1245327725
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
R6B25 Issued in MO
Practice address
6500 Lansdowne Ave
Saint Louis, MO 63109-2654
Phone
(314) 352-7003
NPI assigned
Oct 6, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X R6B25 MO Primary

Addresses

Primary practice location

6500 Lansdowne Ave
Saint Louis, MO 63109-2654

Mailing address

6500 Lansdowne Ave
Saint Louis, MO 63109-2654
Phone (314) 352-7003

Other identifiers 1

IdentifierTypeStateIssuer
201567013MedicaidMO

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
I20101019000933 MO Practitioner - General Practice 0749473031 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
University of Missouri, Kansas City, School of Medicine, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

6500 Lansdowne Ave
Saint Louis, MO 63109-2654
Phone (314) 352-7003

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R6B25MOMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Doctor's Office, Inc. General Practice CurrentSince Dec 31, 1991 Accepting new patients
Jpam Management & Consulting Inc Past Accepting new patients
Woodland Manor of Arnold LLC Past Accepting new patients
Delmar Gardens of South County, Inc. Past Accepting new patients
Alexian Brothers Sherbrooke Village Past Accepting new patients

Locations

6500 Lansdowne Ave
Saint Louis, MO 63109
Phone (314) 352-7003

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/GIGFCA/Endpoint/GIGFCA

Organizations & group practices 5

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 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": "1160092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1245327725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6500 LANSDOWNE AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631092654",
            "telephone_number": "314-352-7003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6500 LANSDOWNE AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631092654",
            "telephone_number": "314-352-7003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WON",
        "first_name": "RUSSELL",
        "middle_name": "KL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MO",
            "license": "R6B25",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201567013",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.