Individual provider Active NPI

Uyen Thuc Phan, M.D.

  • Hospitalist Physician
  • Saint Louis, MO
National Provider Identifier
1427498286
Registry record updated Oct 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
2016023716 Issued in MO
Practice address
11133 Dunn Rd Ste 2427
Saint Louis, MO 63136-6163
Phone
(314) 653-5643
NPI assigned
Jun 26, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2016023716 MO
Family Medicine Physician 207Q00000X 06299 GA
Hospitalist Physician 208M00000X 2016023716 MO Primary

Addresses

Primary practice location

11133 Dunn Rd Ste 2427
Saint Louis, MO 63136-6163

Mailing address

11133 Dunn Rd Ste 2427
Saint Louis, MO 63136-6163
Phone (314) 653-5643

Other practice location 1

17065 S Outer Rd
Belton, MO 64012-2165
Phone (816) 348-1272

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Health Information Exchange (HIE)

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161011002280 MO Practitioner - Family PracticePractitioner - Hospitalist 4688800063 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Hospitalist
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physician Groups LCGroup PAC ID 3072421254, 526 clinicians

Practice addresses (Care Compare)

11133 Dunn Rd
Suite 2427
Saint Louis, MO 63136-6163
Phone (314) 653-5643

Hospital & facility affiliations

  • BJC Hospice Hospice, Saint Louis, MO, CCN 261511
  • Christian Hospital Northeast Hospital, Saint Louis, MO, CCN 260180

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
06299GAMDFamily Medicine Physician
2016023716MOMDHospitalist Physician
006299GAMDPediatric Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Inpatient Consultants of Kansas PA Family Medicine CurrentSince Nov 1, 2016 Accepting new patients
Southeastern Physician Services PC Hospitalist CurrentSince Sep 27, 2017 Accepting new patients
Inpatient Consultants of Kansas PA Family Medicine Current Accepting new patients
Physician Groups LC Family Medicine CurrentSince Nov 1, 2021 Accepting new patients
Physician Groups LC CurrentSince Nov 1, 2021 Accepting new patients
Christian Hospital Northeast- Northwest Past Accepting new patients

Locations

19600 E 39th St S
Independence, MO 64057
Phone (816) 698-7000

2525 Glenn Hendren Dr
Liberty, MO 64068
Phone (816) 781-7200

2630 Highway K
O Fallon, MO 63368
Phone (636) 240-5454

3015 N Ballas Rd
Saint Louis, MO 63131
Phone (314) 996-5330

11133 Dunn Rd
Ste 2427
Saint Louis, MO 63136
Phone (314) 653-5643

10 Hospital Dr
Saint Peters, MO 63376
Phone (636) 394-2522

Interoperability endpoints

  • FHIR API: https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

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 and National Provider Directory roles.

Hospital & facility affiliations 3

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": "1372204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633564800000",
    "number": "1427498286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11133 DUNN RD STE 2427",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631366163",
            "telephone_number": "314-653-5643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11133 DUNN RD STE 2427",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631366163",
            "telephone_number": "314-653-5643"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17065 S Outer Rd",
            "address_purpose": "LOCATION",
            "city": "Belton",
            "state": "MO",
            "postal_code": "640122165",
            "country_code": "US",
            "telephone_number": "816-348-1272",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHAN",
        "first_name": "UYEN",
        "middle_name": "THUC",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-26",
        "last_updated": "2021-10-07",
        "certification_date": "2021-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2016023716",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "06299",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MO",
            "license": "2016023716",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "11133 Dunn Rd Ste 2427",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631366163",
            "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.