NPIMap

Individual provider Active NPI

Roberto Perez, M.D.

  • Internal Medicine Physician
  • Saint Louis, MO
National Provider Identifier
1417972894
Registry record updated Nov 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
R8960 Issued in MO
Practice address
30 Ronnies PLZ
Saint Louis, MO 63126-3552
Phone
(314) 748-5800
NPI assigned
Jul 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X R8960 MO Primary

Addresses

Primary practice location

30 Ronnies PLZ
Saint Louis, MO 63126-3552

Mailing address

PO Box 955534
Saint Louis, MO 63195-5534

Other practice location 1

3555 Sunset Office Dr
C100
Saint Louis, MO 63127-1015
Phone (314) 238-9100

Other identifiers 1

IdentifierTypeStateIssuer
201247301MedicaidMO

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address rperez23048@direct-ehr-ssmhc.com Direct
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other

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
I20071130000193 MO Practitioner - Internal Medicine 0749239812 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1976
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
SSM Medical Group IncGroup PAC ID 6608776299, 565 clinicians

Practice addresses (Care Compare)

1035 Bellevue Ave
Suite 500
Saint Louis, MO 63117-1843
Phone (314) 925-4770

30 Ronnies PLZ
Saint Louis, MO 63126-3552
Phone (314) 748-5800

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R8960MOMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
SSM Medical Group Inc. CurrentSince Sep 1, 2006 Accepting new patients
SSM Medical Group, Inc. Internal Medicine CurrentSince Dec 1, 2007 Accepting new patients
SSM Health Care St. Louis Internal Medicine Past Accepting new patients

Locations

1551 Wall St
Ste 310
Saint Charles, MO 63303
Phone (636) 669-2268

1035 Bellevue Ave
Ste 500
Saint Louis, MO 63117
Phone (314) 647-1115

3555 Sunset Office Dr
Ste C100
Saint Louis, MO 63127
Phone (314) 238-9100

30 Ronnies Plz
Sappington, MO 63126
Phone (314) 748-5800

Interoperability endpoints

  • Direct secure messaging: rperez23048@direct-ehr-ssmhc.com

Organizations & group practices 3

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.

Hospital & facility affiliations 8

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": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605830400000",
    "number": "1417972894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 955534",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631955534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 RONNIES PLZ",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631263552",
            "telephone_number": "314-748-5800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3555 Sunset Office Dr",
            "address_2": "C100",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631271015",
            "country_code": "US",
            "telephone_number": "314-238-9100",
            "fax_number": "314-238-9110",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PEREZ",
        "first_name": "ROBERTO",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-13",
        "last_updated": "2020-11-20",
        "certification_date": "2020-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "R8960",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201247301",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rperez23048@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "rperez23048@direct-ehr-ssmhc.com",
            "address_1": "30 Ronnies Plz",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631263552",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "30 Ronnies Plz",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631263552",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.