Individual provider Active NPI

Majdee Islam, M.D.

  • Urology Physician
  • Saint Peters, MO
National Provider Identifier
1447645304
Registry record updated Sep 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
202103769 Issued in MO
Practice address
112 Piper Hill Dr Ste 12
Saint Peters, MO 63376-1690
Phone
(636) 996-9202
NPI assigned
Mar 30, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2022

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X A170568 CA
Urology Physician 208800000X 036158975 IL
Student in an Organized Health Care Education/Training Program 390200000X CO
Urology Physician 208800000X 202103769 MO Primary

Addresses

Primary practice location

112 Piper Hill Dr Ste 12
Saint Peters, MO 63376-1690

Mailing address

12855 N 40 Dr Ste 375
Saint Louis, MO 63141-8657
Phone (314) 567-6071

Other practice location 1

326 Fountains Pkwy
Fairview Heights, IL 62208-2041
Phone (618) 277-3109

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, IL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20211109000259 MO Practitioner - Urology 5799098562 Reassigns benefits to 2 organizations
I20220614002293 IL Practitioner - Urology 5799098562 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Urology of St Louis IncGroup PAC ID 6204723786, 112 clinicians

Practice addresses (Care Compare)

12855 N 40 Dr
Suite 375
Saint Louis, MO 63141-8657
Phone (314) 567-6071

6812 State Route 162 200
Maryville, IL 62062-8562
Phone (618) 288-0900

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
21386WIMDFamily Medicine Physician
A170568CAMDUrology Physician
202103769MOMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Urology of St. Louis, Inc. Urology CurrentSince Aug 1, 2022 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Nov 22, 2021 Accepting new patients
Urology of St. Louis, Inc. CurrentSince Aug 1, 2022 Accepting new patients
Osf Multi-Specialty Group CurrentSince Aug 1, 2022 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Nov 22, 2021 Accepting new patients
Urology of St. Louis, Inc. Urology Past Accepting new patients

Locations

2 Saint Anthonys Way
Ste 300
Alton, IL 62002
Phone (618) 462-2226

2 Memorial Dr
Ste 102
Alton, IL 62002
Phone (618) 288-0900

326 Fountains Pkwy
Fairview Heights, IL 62208
Phone (618) 277-3109

2044 Madison Ave
Ste G7
Granite City, IL 62040
Phone (314) 500-2424

6812 State Route 162
Ste 200
Maryville, IL 62062
Phone (618) 288-0900

3 Saint Elizabeth Blvd
Ste 3200
O Fallon, IL 62269
Phone (618) 489-8030

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

12855 N 40 Dr
Ste 375
Saint Louis, MO 63141

12855 N 40 Dr
Ste Ll
Saint Louis, MO 63141

12855 N 40 Dr
Saint Louis, MO 63141
Phone (314) 432-4415

112 Piper Hill Dr
Ste 12
Saint Peters, MO 63376
Phone (314) 806-1770

1965 S Fremont Ave
Ste 370
Springfield, MO 65804
Phone (417) 820-0300

2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905

Interoperability endpoints

  • Direct secure messaging: majdeeislam@slus.allscriptsdirect.net
  • Direct secure messaging: mislam@yourcarecommunity.org

Organizations & group practices 7

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 5

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": "1427673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662681600000",
    "number": "1447645304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12855 N 40 DR STE 375",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418657",
            "telephone_number": "314-567-6071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 PIPER HILL DR STE 12",
            "city": "SAINT PETERS",
            "state": "MO",
            "postal_code": "633761690",
            "telephone_number": "636-996-9202"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "326 Fountains Pkwy",
            "address_purpose": "LOCATION",
            "city": "Fairview Heights",
            "state": "IL",
            "postal_code": "622082041",
            "country_code": "US",
            "telephone_number": "618-277-3109",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ISLAM",
        "first_name": "MAJDEE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-03-30",
        "last_updated": "2022-09-09",
        "certification_date": "2022-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "CA",
            "license": "A170568",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "IL",
            "license": "036158975",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CO",
            "license": null,
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "MO",
            "license": "202103769",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Peters, MO

Sources for this page

Verify at the official NPI Registry.