NPIMap

Individual provider Active NPI

Ameesh Dara, D.O.

  • Nephrology Physician
  • Saint Louis, MO
National Provider Identifier
1417367244
Registry record updated Mar 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
2019015695 Issued in MO
Practice address
777 S New Ballas Rd Ste 328W
Saint Louis, MO 63141-8748
Phone
(314) 869-0370
Fax
(314) 869-5098
NPI assigned
May 1, 2014
Last updated
Mar 19, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 036.148828 IL
Student in an Organized Health Care Education/Training Program 390200000X
Nephrology Physician 207RN0300X 2019015695 MO Primary

Addresses

Primary practice location

777 S New Ballas Rd Ste 328W
Saint Louis, MO 63141-8748

Mailing address

1234 Lay Rd
Saint Louis, MO 63124-1872
Phone (314) 456-6659

Other practice location 1

4100 Union Blvd Unit B
Saint Louis, MO 63115-1225
Phone (314) 531-1112

Other practice location 2

4100 Union Blvd Unit B1
Saint Louis, MO 63115-1225
Phone (314) 869-0370

Other practice location 3

1224 Graham Rd Ste 1111
Florissant, MO 63031-8028
Phone (314) 869-0370

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190924003212 MO Practitioner - NephrologyPractitioner - Internal Medicine 7618279159 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Kansas City University of Physicians and Surgeons, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Metro St Louis Renal Services IncGroup PAC ID 0941224547, 2 clinicians

Practice addresses (Care Compare)

4100 Union Blvd
Saint Louis, MO 63115-1225
Phone (314) 869-0370

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
036.148828ILMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Medical Associates, LLC Nephrology CurrentSince Aug 20, 2019 Accepting new patients

Locations

1224 Graham Rd
Ste 1111
Florissant, MO 63031
Phone (314) 837-3720

4100 Union Blvd
#B
Saint Louis, MO 63115
Phone (314) 531-1112

Organizations & group practices 2

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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1398902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647648000000",
    "number": "1417367244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1234 LAY RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631241872",
            "telephone_number": "314-456-6659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 S NEW BALLAS RD STE 328W",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418748",
            "telephone_number": "314-869-0370",
            "fax_number": "314-869-5098"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4100 Union Blvd Unit B",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631151225",
            "country_code": "US",
            "telephone_number": "314-531-1112",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4100 Union Blvd Unit B1",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631151225",
            "country_code": "US",
            "telephone_number": "314-869-0370",
            "fax_number": "314-869-5098",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1224 Graham Rd Ste 1111",
            "address_purpose": "LOCATION",
            "city": "Florissant",
            "state": "MO",
            "postal_code": "630318028",
            "country_code": "US",
            "telephone_number": "314-869-0370",
            "fax_number": "314-869-5098",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DARA",
        "first_name": "AMEESH",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-01",
        "last_updated": "2022-03-19",
        "certification_date": "2022-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "IL",
            "license": "036.148828",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "MO",
            "license": "2019015695",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.