Colleen M. Fitzpatrick, MD

Primary specialty

Pediatric Surgery PhysicianTaxonomy code 2086S0120X

License

2012023503 Issued in MO

Practice address

1465 S Grand Blvd
Pediatric Surgery
Saint Louis, MO 63104-1003

Phone

(314) 577-5629

Fax

(314) 268-6454

NPI assigned

Jul 3, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Networks

• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H3359

Interoperability endpoints

• Direct secure messaging: cfitzpatrick1478634@nychhc.direct-ci.com
• Direct secure messaging: cfitzpatrick67699@northwell.direct-ci.com

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.

• North Shore-Lij Medical PC

  • Urology Physician
  • Great Neck, NY
  • NPI 1053688572
  Medicare reassignment
• Bexar Pediatric Surgery Associates PLLC

  • Specialist
  • San Antonio, TX
  • NPI 1942251210
  NPD (past)
• Long Island Jewish Medical Center

  • Children's Hospital
  • New Hyde Park, NY
  • NPI 1174530349
  NPD (past)
• Long Island Jewish Medical Center

  • General Acute Care Hospital
  • New Hyde Park, NY
  • NPI 1285641514
  NPD (past)
• Magella Medical Associates Billing, Inc.

  • Neonatal-Perinatal Medicine Physician
  • Round Rock, TX
  • NPI 1083631071
  NPD (past)

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

{
    "created_epoch": "1183420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456444800000",
    "number": "1417155383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1465 S GRAND BLVD",
            "address_2": "PEDIATRIC SURGERY",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631041003",
            "telephone_number": "314-577-5629",
            "fax_number": "314-268-6454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1465 S GRAND BLVD",
            "address_2": "PEDIATRIC SURGERY",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631041003",
            "telephone_number": "314-577-5629",
            "fax_number": "314-268-6454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FITZPATRICK",
        "first_name": "COLLEEN",
        "middle_name": "M.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-03",
        "last_updated": "2016-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": "MO",
            "license": "2012023503",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Haley Danielle Fitzgibbons, MSW, LCSW
• Mary Fitzgibbons, PH.D
• Sean C Fitzmaurice, MD
• Brendan Michael Fitzpatrick, M.D.
• Brittany Nicole Fitzpatrick, MD
• Ellen E. Fitzsimmons-Craft, PHD, LP
• Shawn Fitzwilliam, PLPC
• Gerald Joseph Fivian, MD, FACS
• Taylor Matthew Fix, DO
• Heather Louise Fjone, MSW, LCSW

• Pediatric Surgery Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Pediatric Surgery Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.