Active NPI
Sandra K. Minchow-Proffitt, M.D.
- Family Medicine Physician
- Kirkwood, MO
National Provider Identifier
1346215787
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 2004008255
- Practice address
- 103 N Taylor Ave, Ste C
Kirkwood, MO 63122-4360 - Phone
- (314) 380-4566
- Fax
- (314) 743-3700
- NPI assigned
- Feb 21, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 2004008255 | MO | Primary |
Addresses
Primary practice location
103 N Taylor Ave, Ste C
Kirkwood, MO 63122-4360
Mailing address
103 N Taylor Ave, Ste C
Kirkwood, MO 63122-4360
Phone (314) 380-4566
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00179906 | Other | MO | RAILROAD MEDICARE |
| 1346215787 | Medicaid | MO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2004008255 | MO | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Missouri Baptist Medical Center | Past | Accepting new patients |
Interoperability endpoints
- sminchowproffitt85@directc.mercy.net
- https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
- mosaic@mfml-mo.direct.office.nextgen.com
Organizations & group practices 1
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.
-
- General Acute Care Hospital
- Saint Louis, MO
- NPI 1487663506
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140480000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1653264000000",
"number": "1346215787",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "103 N TAYLOR AVE, STE C",
"city": "KIRKWOOD",
"state": "MO",
"postal_code": "631224360",
"telephone_number": "314-380-4566",
"fax_number": "314-743-3700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "103 N TAYLOR AVE, STE C",
"city": "KIRKWOOD",
"state": "MO",
"postal_code": "631224360",
"telephone_number": "314-380-4566",
"fax_number": "314-743-3700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MINCHOW-PROFFITT",
"first_name": "SANDRA",
"middle_name": "K.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-02-21",
"last_updated": "2022-05-23",
"certification_date": "2022-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MO",
"license": "2004008255",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00179906",
"state": "MO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1346215787",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kirkwood, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.