Metro Hypertension & Kidney Center PC

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

Legal business name

METRO HYPERTENSION & KIDNEY CENTER PC

Practice address

1400 US Highway 61 Ste 240
Festus, MO 63028-4141

Phone

(636) 937-3337

Fax

(636) 931-7671

NPI assigned

Jun 16, 2006

Organization subpart

No

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

Authorized official

Name

Donovan C Polack

Title

MD

Phone

(314) 432-2580

Specialties & licenses 3

Addresses

Other identifiers 1

Locations

Practitioners 1

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

• Theodore Ikechukwu Otti, M.D.

  • Nephrology Physician
  • Richmond Heights, MO
  • NPI 1316950884
  NPD (past)

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521504000000",
    "number": "1386688646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1449",
            "city": "MARYLAND HEIGHTS",
            "state": "MO",
            "postal_code": "630430449",
            "telephone_number": "314-432-2580",
            "fax_number": "314-432-0223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 US HIGHWAY 61 STE 240",
            "city": "FESTUS",
            "state": "MO",
            "postal_code": "630284141",
            "telephone_number": "636-937-3337",
            "fax_number": "636-931-7671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "METRO HYPERTENSION & KIDNEY CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-16",
        "last_updated": "2018-03-20",
        "status": "A",
        "authorized_official_last_name": "POLACK",
        "authorized_official_first_name": "DONOVAN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "314-432-2580"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "MO",
            "license": "2000155017",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "MO",
            "license": "R5H69",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DC5238",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mercy Pharmacy Services, LLC (Mercy Pharmacy Jefferson)
• Sean Merk, DPT
• Amie Lynn Merz
• Jennifer Messersmith
• Metro Heart Group of St. Louis, Inc. (Metro Heart Group)
• Amy Metzner-Zelle
• Katherine R Meyer, OCCUPATIONAL THERAPI
• Tessa Darlene Michaud, MSW, LCSW
• Tjode M Mickelson, D.C
• Micro LLC

• Nephrology Physician in Festus, MO
• Providers in Festus, MO by specialty
• Nephrology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2018; 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.