NPIMap

Individual provider Active NPI

Theodore Ikechukwu Otti, M.D.

  • Nephrology Physician
  • Richmond Heights, MO
National Provider Identifier
1316950884
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
103005 Issued in MO
Practice address
1035 Bellevue Ave Ste 315
Richmond Heights, MO 63117-1856
Phone
(314) 683-6110
Fax
(314) 485-2136
NPI assigned
Aug 14, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 103005 MO Primary

Addresses

Primary practice location

1035 Bellevue Ave Ste 315
Richmond Heights, MO 63117-1856

Mailing address

PO Box 4031
Chesterfield, MO 63006-4031
Phone (314) 577-5778

Other practice location 1

3535 S Jefferson Ave
Suite 201
Saint Louis, MO 63118-3930
Phone (314) 577-5778

Other identifiers 1

IdentifierTypeStateIssuer
208601823MedicaidMO

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
I20080827000043 MO Practitioner - NephrologyPractitioner - Internal Medicine 4789633348 Practice locations: St Louis, MO; Richmond Heights, MO

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1035 Bellevue Ave
Suite 315
Richmond Heights, MO 63117-1856
Phone (314) 683-6110

11133 Dunn Rd
Saint Louis, MO 63136-6119
Phone (314) 653-5000

2610 Clark Ave
Saint Louis, MO 63103-2502
Phone (314) 534-0909

6420 Clayton Rd
Saint Louis, MO 63117-1811
Phone (314) 768-8000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Metro Hypertension & Kidney Center PC Nephrology Past Accepting new patients
Saint Louis Connectcare Nephrology Past Accepting new patients
Saint Louis Connectcare Past Accepting new patients
Hypertension and Kidney Center of St. Louis, LLC Nephrology Past Accepting new patients
Critical Care Services, P.C. Past Accepting new patients

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 4

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": "1155513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1316950884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4031",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630064031",
            "telephone_number": "314-577-5778",
            "fax_number": "636-939-1629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1035 BELLEVUE AVE STE 315",
            "city": "RICHMOND HEIGHTS",
            "state": "MO",
            "postal_code": "631171856",
            "telephone_number": "314-683-6110",
            "fax_number": "314-485-2136"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3535 S Jefferson Ave",
            "address_2": "SUITE 201",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631183930",
            "country_code": "US",
            "telephone_number": "314-577-5778",
            "fax_number": "636-939-1629",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OTTI",
        "first_name": "THEODORE",
        "middle_name": "IKECHUKWU",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-14",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "MO",
            "license": "103005",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208601823",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Richmond Heights, MO

Sources for this page

Verify at the official NPI Registry.