NPIMap

Individual provider Active NPI

Srinivasan Raghavan, M.D.

  • Internal Medicine Physician
  • Saint Louis, MO
National Provider Identifier
1265444608
Registry record updated Mar 14, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2000143921 Issued in MO
Practice address
12700 Southfork Road
Suite 220
Saint Louis, MO 63128-2106
Phone
(314) 543-5942
Fax
(314) 543-5947
NPI assigned
Aug 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2017

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 2000143921 MO Primary

Addresses

Primary practice location

12700 Southfork Road
Suite 220
Saint Louis, MO 63128-2106

Mailing address

12700 Southfork Rd
Ste 220
Saint Louis, MO 63128-3201
Phone (314) 543-5942

Other identifiers 1

IdentifierTypeStateIssuer
204965008MedicaidMO

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
I20040618000865 MO Practitioner - Internal Medicine 5799760450 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ste Genevieve County Memorial HospitalGroup PAC ID 3274432802, shared by 9 NPIs, 74 clinicians

Practice addresses (Care Compare)

255 Boderman
Bloomsdale, MO 63627-9099
Phone (573) 483-9492

753 Pointe Basse Dr
Ste Genevieve, MO 63670-1820
Phone (573) 883-2782

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ste. Genevieve County Memorial Hospital CurrentSince Jan 1, 2018 Accepting new patients
Ste Genevieve County Memorial Hospital CurrentSince Jan 1, 2018 Accepting new patients
Ste Genevieve County Memorial Hospital CurrentSince Jun 10, 2019 Accepting new patients
Inpatient Consultants of Missouri Inc Internal Medicine Past Accepting new patients
Riverview at the Park, Inc Past Accepting new patients

Locations

255 Boderman
Bloomsdale, MO 63627
Phone (573) 483-2727

3015 N Ballas Rd
Saint Louis, MO 63131
Phone (314) 996-5330

800 Ste Genevieve Dr
Ste Genevieve, MO 63670
Phone (573) 883-2571

753 Pointe Basse Dr
Ste Genevieve, MO 63670
Phone (573) 883-2782

Interoperability endpoints

  • Direct secure messaging: srinivasanraghavan@mhccaremail.com

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": "1155427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489449600000",
    "number": "1265444608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12700 SOUTHFORK RD",
            "address_2": "STE 220",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631283201",
            "telephone_number": "314-543-5942",
            "fax_number": "314-543-5947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12700 SOUTHFORK ROAD",
            "address_2": "SUITE 220",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631282106",
            "telephone_number": "314-543-5942",
            "fax_number": "314-543-5947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAGHAVAN",
        "first_name": "SRINIVASAN",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-13",
        "last_updated": "2017-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2000143921",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "204965008",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.