NPIMap

Individual provider Active NPI

Mohammed Ali Abbas, M.D.

  • Vascular & Interventional Radiology Physician
  • Fenton, MO
National Provider Identifier
1306057310
Registry record updated Dec 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
2007022042 Issued in MO
Practice address
1011 Bowles Ave Ste 220
Fenton, MO 63026-2384
Phone
(636) 681-3030
Fax
(636) 326-1545
NPI assigned
May 24, 2007
Last updated
Dec 31, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 31, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 2006016918 MO
Vascular & Interventional Radiology Physician 2085R0204X 2007022042 MO Primary

Addresses

Primary practice location

1011 Bowles Ave Ste 220
Fenton, MO 63026-2384

Mailing address

1011 Bowles Ave Ste 220
Fenton, MO 63026-2384
Phone (636) 681-3030

Other practice location 1

1402 S Grand Blvd Rm 260
Saint Louis, MO 63104-1004
Phone (314) 977-9853

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
I20120804000028 MO Practitioner - Diagnostic RadiologyPractitioner - Interventional Radiology 4688820855 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic RadiologyAlso: Interventional Radiology
Education
University of Toledo College of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physician Specialists of St Lukes LLCGroup PAC ID 1557366960, 77 clinicians
Diagnostic Imaging Associates LTDGroup PAC ID 9638064942, 19 clinicians

Practice addresses (Care Compare)

232 S Woods Mill Rd
Chesterfield, MO 63017-3406
Phone (314) 434-1500

232 S Woods Mill Rd
St Lukes Hosp Radiology Dept
Chesterfield, MO 63017-3417
Phone (314) 434-1500

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2006016918MOMDDiagnostic Radiology Physician
2007022042MOMDVascular & Interventional Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Diagnostic Imaging Associates LTD Diagnostic Radiology CurrentSince Jul 1, 2024 Accepting new patients
Physician Specialists of St Lukes LLC CurrentSince Dec 1, 2025 Accepting new patients
Emergency Physicians of St. Luke's, LLC Past Accepting new patients

Locations

6 McBride and Son Center Dr
Ste 101
Chesterfield, MO 63005
Phone (636) 519-7865

233 Clarkson Rd
Ellisville, MO 63011
Phone (636) 256-8644

232 S Woods Mill Rd
Town and Country, MO 63017
Phone (314) 205-6030

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 6

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": "1179964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703980800000",
    "number": "1306057310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 BOWLES AVE STE 220",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630262384",
            "telephone_number": "636-681-3030",
            "fax_number": "636-326-1545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 BOWLES AVE STE 220",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630262384",
            "telephone_number": "636-681-3030",
            "fax_number": "636-326-1545"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1402 S Grand Blvd Rm 260",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631041004",
            "country_code": "US",
            "telephone_number": "314-977-9853",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ABBAS",
        "first_name": "MOHAMMED",
        "middle_name": "ALI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-24",
        "last_updated": "2023-12-31",
        "certification_date": "2023-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MO",
            "license": "2006016918",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "MO",
            "license": "2007022042",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fenton, MO

Sources for this page

Verify at the official NPI Registry.