Active NPI
Achraf Hani Jardaly, MD
- Student in an Organized Health Care Education/Training Program
- Saint Louis, MO
National Provider Identifier
1245971563
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 1201 S Grand Blvd
Saint Louis, MO 63104-1016 - Phone
- (314) 977-9851
- NPI assigned
- Apr 2, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
1201 S Grand Blvd
Saint Louis, MO 63104-1016
Mailing address
3701 4TH Ave
Columbus, GA 31904-7441
Phone (470) 452-8878
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220720001456 | MO | Order and Referring Only - Orthopedic Surgery | 9335520477 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1648857600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1648857600000",
"number": "1245971563",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3701 4TH AVE",
"city": "COLUMBUS",
"state": "GA",
"postal_code": "319047441",
"telephone_number": "470-452-8878"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1201 S GRAND BLVD",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631041016",
"telephone_number": "314-977-9851"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JARDALY",
"first_name": "ACHRAF",
"middle_name": "HANI",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-04-02",
"last_updated": "2022-04-02",
"certification_date": "2022-04-02",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.