NPIMap

Individual provider Active NPI

Kevin L. Threlkeld, M.D.

  • Internal Medicine Physician
  • Chesterfield, MO
National Provider Identifier
1295703445
Registry record updated Dec 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MDR5P58 Issued in MO
Practice address
121 Saint Lukes Center Dr Ste 402
Chesterfield, MO 63017-3519
Phone
(314) 205-6160
Fax
(314) 590-5918
NPI assigned
Mar 12, 2006
Last updated
Dec 4, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 4, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MDR5P58 MO Primary
Internal Medicine Physician 207R00000X R5P58 MO

Addresses

Primary practice location

121 Saint Lukes Center Dr Ste 402
Chesterfield, MO 63017-3519

Mailing address

121 Saint Lukes Center Dr Ste 402
Chesterfield, MO 63017-3519
Phone (314) 205-6160

Other practice location 1

204 N Main St
O Fallon, MO 63366-2203
Phone (636) 390-1854

Other identifiers 1

IdentifierTypeStateIssuer
207969510MedicaidMO

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
I20070109000406 MO Practitioner - Internal MedicinePractitioner - Pathology 5395745798 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Missouri, Kansas City, School of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Conway Internists, LLCGroup PAC ID 5294751152, 3 clinicians

Practice addresses (Care Compare)

121 Saint Lukes Ctr Dr
Chesterfield, MO 63017-3519
Phone (314) 205-6160

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MDR5P58MOMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Lukes Medical Group Internal Medicine Past Accepting new patients
Ozarks Medical Center Past Accepting new patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1142121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607040000000",
    "number": "1295703445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 SAINT LUKES CENTER DR STE 402",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630173519",
            "telephone_number": "314-205-6160",
            "fax_number": "314-590-5918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 SAINT LUKES CENTER DR STE 402",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630173519",
            "telephone_number": "314-205-6160",
            "fax_number": "314-590-5918"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "204 N Main St",
            "address_purpose": "LOCATION",
            "city": "O Fallon",
            "state": "MO",
            "postal_code": "633662203",
            "country_code": "US",
            "telephone_number": "636-390-1854",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THRELKELD",
        "first_name": "KEVIN",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-12",
        "last_updated": "2020-12-04",
        "certification_date": "2020-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "MDR5P58",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "R5P58",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "207969510",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chesterfield, MO

Sources for this page

Verify at the official NPI Registry.