Individual provider Active NPI

Modupe Adedamola Aderibigbe, D.P.M.

  • Podiatrist
  • Saint Louis, MO
National Provider Identifier
1407092927
Registry record updated Aug 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
2011018632 Issued in MO
Practice address
401 Holly Hills Ave
Saint Louis, MO 63111-2410
Phone
(314) 353-5190
Fax
(314) 353-7631
NPI assigned
Jan 6, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2026

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 016005470 IL
Podiatrist 213E00000X 2011018632 MO Primary
Primary Podiatric Medicine Podiatrist 213EP1101X 5901002232 MI
Foot & Ankle Surgery Podiatrist 213ES0103X 5901002232 MI

Addresses

Primary practice location

401 Holly Hills Ave
Saint Louis, MO 63111-2410

Mailing address

3824 S Grand Blvd
Saint Louis, MO 63118-3412
Phone (314) 814-8180

Other practice location 1

3824 S Grand Blvd
Saint Louis, MO 63118-3412
Phone (314) 814-8180

Other practice location 2

4352 Manchester Ave
Saint Louis, MO 63110-2138
Phone (314) 531-5444

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110926000851 MO Practitioner - Podiatry 6709937378 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aria Podiatry Care PLLCGroup PAC ID 2567822661, 53 clinicians
Carestl HealthGroup PAC ID 1557269289, shared by 7 NPIs, 14 clinicians

Practice addresses (Care Compare)

1121 N Orleans St
Chicago, IL 60610-2511
Phone (877) 674-1211

5471 Dr Martin Luther King Dr
Saint Louis, MO 63112-4265
Phone (314) 367-5820

7047 Emma Ave
Jennings, MO 63136-1049
Phone (314) 653-8070

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue19
Removal or shaving of skin growth17

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
016005470ILMDPodiatrist
2011018632MOMDPodiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Carestl Health CurrentSince Apr 1, 2014 Accepting new patients
Family Care Health Centers CurrentSince Aug 24, 2026 Accepting new patients
Family Care Health Centers CurrentSince Aug 24, 2026 Accepting new patients
Carestl Health Current Accepting new patients
Carestl Health CurrentSince Apr 1, 2014 Accepting new patients

Locations

3312 Ashby Rd
Saint Ann, MO 63074
Phone (314) 493-6200

1218 Shepley Dr
Saint Louis, MO 63137
Phone (314) 367-8520

3824 S Grand Blvd
Saint Louis, MO 63118
Phone (314) 481-1615

11300 Dunn Rd
Saint Louis, MO 63138
Phone (505) 999-9290

5541 Riverview Blvd
Saint Louis, MO 63120
Phone (314) 389-4566

4352 Manchester Ave
Saint Louis, MO 63110
Phone (314) 371-0336

401 Holly Hills Ave
Saint Louis, MO 63111
Phone (314) 353-5190

5471 Martin Luther King Dr
Saint Louis, MO 63112
Phone 3143675820 ext. 2221

7047 Emma Ave
Saint Louis, MO 63136
Phone (314) 653-8070

4500 Pope Ave
Saint Louis, MO 63115
Phone 3143675820 ext. 84940

Interoperability endpoints

  • Direct secure messaging: modupe.aderibigbe@cstl.eclinicaldirectplus.com

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1231200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786406400000",
    "number": "1407092927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3824 S GRAND BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631183412",
            "telephone_number": "314-814-8180",
            "fax_number": "314-814-8188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 HOLLY HILLS AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631112410",
            "telephone_number": "314-353-5190",
            "fax_number": "314-353-7631"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3824 S Grand Blvd",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631183412",
            "country_code": "US",
            "telephone_number": "314-814-8180",
            "fax_number": "314-814-8188",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4352 Manchester Ave",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631102138",
            "country_code": "US",
            "telephone_number": "314-531-5444",
            "fax_number": "314-531-0063",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ADERIBIGBE",
        "first_name": "MODUPE",
        "middle_name": "ADEDAMOLA",
        "name_prefix": "Dr.",
        "credential": "D.P.M.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-01-06",
        "last_updated": "2026-08-11",
        "certification_date": "2026-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "IL",
            "license": "016005470",
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "MO",
            "license": "2011018632",
            "primary": true
        },
        {
            "code": "213EP1101X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "MI",
            "license": "5901002232",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "MI",
            "license": "5901002232",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.