Individual provider Active NPI

Nishant Victor Raj, MD

  • Surgery Physician
  • Saint Louis, MO
National Provider Identifier
1245473156
Registry record updated Apr 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
2014009230 Issued in MO
Practice address
11155 Dunn Rd
Div Sur Accs, Ste 108N
Saint Louis, MO 63136-6150
Phone
(314) 362-5298
Fax
(888) 824-2176
NPI assigned
Apr 8, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Critical Care Physician 2086S0102X 2014009230 MO
Surgery Physician 208600000X 2014009230 MO Primary

Addresses

Primary practice location

11155 Dunn Rd
Div Sur Accs, Ste 108N
Saint Louis, MO 63136-6150

Mailing address

PO Box 7412011
Chicago, IL 60674-2011
Phone (314) 362-5298

Other identifiers 1

IdentifierTypeStateIssuer
200017562MedicaidMO

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: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140930001811 MO Practitioner - General Surgery 5193945947 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Washington UniversityGroup PAC ID 9830008770, 2,968 clinicians

Practice addresses (Care Compare)

11155 Dunn Rd
Saint Louis, MO 63136-6150
Phone (314) 653-5806

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.2 of 100Reported as group
Quality
71.6
Promoting interoperability
100
Improvement activities
40
Cost
75.75

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)1-10
Melanoma (skin cancer) excision1-10
Removal of tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Washington University CurrentSince Mar 1, 2017 Accepting new patients
Washington University CurrentSince Mar 1, 2017 Accepting new patients
Physician Groups LC Past Accepting new patients

Locations

2630 Highway K
O Fallon, MO 63368
Phone (636) 240-5454

11133 Dunn Rd
Ste 300N
Saint Louis, MO 63136
Phone (314) 953-8300

11155 Dunn Rd
Ste 109N
Saint Louis, MO 63136
Phone (314) 837-3784

11155 Dunn Rd
Ste 108N
Saint Louis, MO 63136
Phone (314) 355-6779

660 S Euclid Ave
Saint Louis, MO 63110

660 S Euclid Ave
#8109
Saint Louis, MO 63110
Phone (314) 362-7841

Interoperability endpoints

  • Direct secure messaging: nraj135079@direct.carenet.org

Organizations & group practices 3

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 4

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": "1239148800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744848000000",
    "number": "1245473156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7412011",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606742011",
            "telephone_number": "314-362-5298",
            "fax_number": "888-824-2176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11155 DUNN RD",
            "address_2": "DIV SUR ACCS, STE 108N",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631366150",
            "telephone_number": "314-362-5298",
            "fax_number": "888-824-2176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAJ",
        "first_name": "NISHANT",
        "middle_name": "VICTOR",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-04-08",
        "last_updated": "2025-04-17",
        "certification_date": "2021-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "MO",
            "license": "2014009230",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MO",
            "license": "2014009230",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200017562",
            "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": "11155 Dunn Rd",
            "address_2": "Div Sur ACCS, Ste 108N",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631366150",
            "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.