Individual provider Active NPI

Gracia Rosario Moncada Andrade, MD

  • Hospitalist Physician
  • Saint Louis, MO
National Provider Identifier
1295408631
Registry record updated Dec 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
2024032087 Issued in MO
Practice address
6420 Clayton Rd
Saint Louis, MO 63117-1811
Phone
(314) 768-8778
Fax
(314) 768-7101
NPI assigned
Jul 30, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 17, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 2021020993 MO
Hospitalist Physician 208M00000X 2024032087 MO Primary

Addresses

Primary practice location

6420 Clayton Rd
Saint Louis, MO 63117-1811

Mailing address

17 Black Oak Dr
Saint Louis, MO 63127-1302
Phone (314) 208-5488

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241029002256 MO Practitioner - Hospitalist 4981137932 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hospitalist
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SSM Health Care GroupGroup PAC ID 0143608372, 929 clinicians

Practice addresses (Care Compare)

1201 S Grand Blvd
Saint Louis, MO 63104-1016
Phone (314) 617-2000

Hospital & facility affiliations

  • SSM Health St Mary'S Hospital - St Louis Hospital, Saint Louis, MO, CCN 260091

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2021020993MOMDInternal Medicine Physician
2024032087MOMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
SSM Health Care Group CurrentSince Oct 1, 2024 Accepting new patients
SSM Health Care Group Single Specialty CurrentSince Oct 1, 2024 Accepting new patients
SSM Health Care St. Louis Past Accepting new patients

Locations

6420 Clayton Rd
Saint Louis, MO 63117
Phone (314) 768-8442

1201 S Grand Blvd
Saint Louis, MO 63104
Phone (314) 257-8222

10101 Woodfield Ln
Saint Louis, MO 63132
Phone (608) 280-4647

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 2

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": "1627603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734393600000",
    "number": "1295408631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 BLACK OAK DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631271302",
            "telephone_number": "314-208-5488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6420 CLAYTON RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631171811",
            "telephone_number": "314-768-8778",
            "fax_number": "314-768-7101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONCADA ANDRADE",
        "first_name": "GRACIA",
        "middle_name": "ROSARIO",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-07-30",
        "last_updated": "2024-12-17",
        "certification_date": "2024-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2021020993",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MO",
            "license": "2024032087",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.