NPIMap

Individual provider Active NPI

Demetrios V Politis, DO

  • Family Medicine Physician
  • Saint Charles, MO
National Provider Identifier
1255417754
Registry record updated Nov 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
R9G32 Issued in MO
Practice address
1475 Kisker Rd Ste 200
Saint Charles, MO 63304-8788
Phone
(636) 498-5850
NPI assigned
Oct 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X R9G32 MO Primary

Addresses

Primary practice location

1475 Kisker Rd Ste 200
Saint Charles, MO 63304-8788

Mailing address

PO Box 955534
Saint Louis, MO 63195-5534

Other practice location 1

14377 Woodlake Dr
Suite #300
Chesterfield, MO 63017-5735
Phone (314) 434-3333

Electronic endpoints 2

TypeEndpointUseAffiliation
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other
Direct Messaging Address dpolitis7573@direct-ehr-ssmhc.com Direct

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
I20090203000446 MO Practitioner - Family Practice 3779512033 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SSM Medical Group IncGroup PAC ID 6608776299, 565 clinicians

Practice addresses (Care Compare)

1475 Kisker Rd
Suite 200
Saint Charles, MO 63304-8788
Phone (636) 498-5850

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R9G32MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
SSM Medical Group Inc. CurrentSince Aug 15, 2018 Accepting new patients
SSM Medical Group, Inc. CurrentSince Aug 15, 2018 Accepting new patients
Des Peres Family Medicine PC Family Medicine CurrentSince Feb 3, 2009 Accepting new patients
Premier Medical Specialists, LLC Past Accepting new patients
Ozarks Medical Center Family Medicine Past Accepting new patients
SSM Health Care St. Louis Past Accepting new patients

Locations

1475 Kisker Rd
Ste 200
Saint Charles, MO 63304
Phone (636) 498-5800

1035 Bellevue Ave
Ste 500
Saint Louis, MO 63117
Phone (314) 647-1115

3555 Sunset Office Dr
Ste C100
Saint Louis, MO 63127
Phone (314) 238-9100

2325 Dougherty Ferry Rd
Ste 104
Saint Louis, MO 63122
Phone (314) 821-6889

Interoperability endpoints

  • Direct secure messaging: dpolitis7573@direct-ehr-ssmhc.com
  • Direct secure messaging: dpolitis171394@directc.mercy.net

Organizations & group practices 6

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 8

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": "1161907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605484800000",
    "number": "1255417754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 955534",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631955534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1475 KISKER RD STE 200",
            "city": "SAINT CHARLES",
            "state": "MO",
            "postal_code": "633048788",
            "telephone_number": "636-498-5850"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14377 Woodlake Dr",
            "address_2": "Suite #300",
            "address_purpose": "LOCATION",
            "city": "Chesterfield",
            "state": "MO",
            "postal_code": "630175735",
            "country_code": "US",
            "telephone_number": "314-434-3333",
            "fax_number": "314-434-6247",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POLITIS",
        "first_name": "DEMETRIOS",
        "middle_name": "V",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-27",
        "last_updated": "2020-11-16",
        "certification_date": "2020-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "R9G32",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "1475 Kisker Rd Ste 200",
            "city": "Saint Charles",
            "state": "MO",
            "country_code": "US",
            "postal_code": "633048788",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dpolitis7573@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "dpolitis7573@direct-ehr-ssmhc.com",
            "address_1": "1475 Kisker Rd Ste 200",
            "city": "Saint Charles",
            "state": "MO",
            "country_code": "US",
            "postal_code": "633048788",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Charles, MO

Sources for this page

Verify at the official NPI Registry.