Active NPI
Vijaya Nattuvetty Vasudevan, M.D.
- Geriatric Medicine (Internal Medicine) Physician
- Saint Peters, MO
National Provider Identifier
1265634513
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Medicine (Internal Medicine) Physician
- License
- 2007007999
- Practice address
- 5401 Veterans Memorial Pkwy Ste 200
Saint Peters, MO 63376-1687 - Phone
- (636) 206-6022
- Fax
- (780) 328-3971
- NPI assigned
- May 31, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Medicine (Internal Medicine) Physician | 207RG0300X | 20020124317 | MO | |
| Geriatric Medicine (Internal Medicine) Physician | 207RG0300X | 2007007999 | MO | Primary |
Addresses
Primary practice location
5401 Veterans Memorial Pkwy Ste 200
Saint Peters, MO 63376-1687
Mailing address
PO Box 173
Saint Charles, MO 63302-0173
Phone (636) 206-6022
Other practice location 1
1002 Peruque Crossing Ct Ste 101
O Fallon, MO 63366-2381
Phone (636) 206-6022
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO, WI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Endocrinology
- Education
- Other, 1987
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
111 W Fulton St
Edgerton, WI 53534-1876
Phone (608) 561-6614
5401 Veterans Memorial Pkwy
Suite 200
Saint Peters, MO 63376-1687
Phone (636) 206-6022
Hospital & facility affiliations
- SSM St Joseph Hospital West
- SSM St Joseph Health Center
- SSM Health Depaul Hospital St Louis
- Barnes-Jewish St Peters Hospital
- Barnes Jewish Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20020124317 | MO | MD | Geriatric Medicine (Internal Medicine) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Edgerton Hospital and Health Services, Inc | Current | Accepting new patients | |
| Edgerton Hospital and Health Services Inc. | Current | Accepting new patients |
Locations
11101 N Sherman Rd
Edgerton, WI 53534
Phone (608) 884-1695
831 Arthur Dr
Milton, WI 53563
Phone (608) 868-3526
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.
-
- Critical Access Hospital
- Edgerton, WI
- NPI 1154350049
-
- Endocrinology, Diabetes & Metabolism Physician
- Saint Peters, MO
- NPI 1659869857
-
- Urgent Care Clinic/Center
- Whitewater, WI
- NPI 1982496295
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Saint Louis, MO
- NPI 1649299827
-
- General Acute Care Hospital
- Saint Peters, MO
- NPI 1144238908
-
- General Acute Care Hospital
- Saint Charles, MO
- NPI 1467521146
-
- General Acute Care Hospital
- Bridgeton, MO
- NPI 1598835308
-
- General Acute Care Hospital
- Lake St Louis, MO
- NPI 1871665380
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719273600000",
"number": "1265634513",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 173",
"city": "SAINT CHARLES",
"state": "MO",
"postal_code": "633020173",
"telephone_number": "636-206-6022",
"fax_number": "780-328-3971"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5401 VETERANS MEMORIAL PKWY STE 200",
"city": "SAINT PETERS",
"state": "MO",
"postal_code": "633761687",
"telephone_number": "636-206-6022",
"fax_number": "780-328-3971"
}
],
"practiceLocations": [
{
"address_1": "1002 Peruque Crossing Ct Ste 101",
"address_purpose": "LOCATION",
"city": "O Fallon",
"state": "MO",
"postal_code": "633662381",
"country_code": "US",
"telephone_number": "636-206-6022",
"fax_number": "780-328-3971",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "VASUDEVAN",
"first_name": "VIJAYA",
"middle_name": "NATTUVETTY",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-31",
"last_updated": "2024-06-25",
"certification_date": "2024-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Geriatric Medicine",
"state": "MO",
"license": "20020124317",
"primary": false
},
{
"code": "207RG0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Geriatric Medicine",
"state": "MO",
"license": "2007007999",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Peters, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2024; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.