Professional Internal Medicine LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

36902 Issued in MO

Legal business name

PROFESSIONAL INTERNAL MEDICINE LLC

Practice address

4625 Lindell Blvd
Suite 507
Saint Louis, MO 63108-3725

Phone

(314) 367-4800

Fax

(314) 367-6400

NPI assigned

May 11, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Kenneth J Rybicki, MD

Title

Physician

Phone

(314) 367-4800

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Roger B Cole, MD

  • General Practice Physician
  • Saint Louis, MO
  • NPI 1235399882
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1305072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305072000000",
    "number": "1376835207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4625 LINDELL BLVD",
            "address_2": "SUITE 507",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631083725",
            "telephone_number": "314-367-4800",
            "fax_number": "314-367-6400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4625 LINDELL BLVD",
            "address_2": "SUITE 507",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631083725",
            "telephone_number": "314-367-4800",
            "fax_number": "314-367-6400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL INTERNAL MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-11",
        "last_updated": "2011-05-11",
        "status": "A",
        "authorized_official_last_name": "RYBICKI",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "314-367-4800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "36902",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Robert Cory Proffer, PHYSICIAN ASSISTANT

• Internal Medicine Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Internal Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.