NPIMap

Individual provider Active NPI

Tahir Qayum, M.D.

  • Internal Medicine Physician
  • Saint Louis, MO
National Provider Identifier
1306907738
Registry record updated Mar 14, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
11011 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
Dec 12, 2006
Last updated
Mar 14, 2017By the provider in NPPES
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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 11011 MO Primary
General Practice Physician 208D00000X 106241 MO

Addresses

Primary practice location

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

Mailing address

9735 Landmark Parkway Dr
Ste 220
Saint Louis, MO 63127-1646
Phone (314) 543-5942

Other identifiers 1

IdentifierTypeStateIssuer
208093419MedicaidMO

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
I20081203000089 MO Practitioner - Internal Medicine 7517028046 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mercy Clinic East CommunitiesGroup PAC ID 7214827922, 573 clinicians

Practice addresses (Care Compare)

12700 Southfork Rd
Suite 200
Saint Louis, MO 63128-3201
Phone (314) 543-5942

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11011MOMDInternal Medicine Physician
106421MOMDUrology Physician
106241MOMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic East Communities CurrentSince Jan 1, 2020 Accepting new patients
Mercy Clinic East Communities Internal Medicine CurrentSince Jan 1, 2020 Accepting new patients
Mercy Hospital South Past Accepting new patients
St. Anthony's Physician Organization Past Accepting new patients
South County Internal Medicine Inc. Internal Medicine Past Accepting new patients

Locations

10010 Kennerly Rd
Saint Louis, MO 63128
Phone (314) 525-1328

12700 Southfork Rd
Ste 200
Saint Louis, MO 63128
Phone (314) 525-4971

12700 Southfork Rd
Ste 220
Saint Louis, MO 63128
Phone (314) 525-1200

5425 Southfield Ctr
Saint Louis, MO 63123
Phone (314) 543-5258

615 S New Ballas Rd
#7T
Saint Louis, MO 63141
Phone (314) 567-4326

615 S New Ballas Rd
Fl 7
Saint Louis, MO 63141
Phone (314) 567-4326

621 S New Ballas Rd
Ste 189A
Saint Louis, MO 63141
Phone (314) 251-6335

621 S New Ballas Rd
Ste 4017B
Saint Louis, MO 63141
Phone (314) 872-9192

9735 Landmark Parkway Dr
Ste 220
Saint Louis, MO 63127

Interoperability endpoints

  • Direct secure messaging: tqayum992395@directc.mercy.net

Organizations & group practices 5

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 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": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489449600000",
    "number": "1306907738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9735 LANDMARK PARKWAY DR",
            "address_2": "STE 220",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631271646",
            "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": "QAYUM",
        "first_name": "TAHIR",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-12",
        "last_updated": "2017-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "11011",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MO",
            "license": "106241",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208093419",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.