Individual provider Active NPI

Charles E Coln, MD

  • Pediatric Surgery Physician
  • Saint Louis, MO
National Provider Identifier
1457430969
Registry record updated Feb 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Surgery PhysicianTaxonomy code 2086S0120X
License
2004016664 Issued in MO
Practice address
621 S New Ballas Rd
Suite 6018B
Saint Louis, MO 63141-8232
Phone
(314) 251-5940
NPI assigned
Nov 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Surgery Physician 2086S0120X 2004016664 MO Primary

Addresses

Primary practice location

621 S New Ballas Rd
Suite 6018B
Saint Louis, MO 63141-8232

Mailing address

621 S New Ballas Rd
Suite 6018B
Saint Louis, MO 63141-8232
Phone (314) 251-5940

Other identifiers 1

IdentifierTypeStateIssuer
208364901MedicaidMO

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
I20041108001102 MO Practitioner - General SurgeryPractitioner - Pediatric Medicine 3971566290 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Children'S Surgery, LLC Pediatric Surgery CurrentSince Mar 25, 2022 Accepting new patients
Mercy Hospitals East Communities Past Accepting new patients

Locations

621 S New Ballas Rd
Ste 6018B
Saint Louis, MO 63141
Phone (314) 251-5940

621 S New Ballas Rd
Ste 483A
Saint Louis, MO 63141
Phone (314) 251-2095

621 S New Ballas Rd
Ste 63B
Saint Louis, MO 63141
Phone (314) 251-3500

Interoperability endpoints

  • Direct secure messaging: ccoln1160@directc.mercy.net

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329696000000",
    "number": "1457430969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 S NEW BALLAS RD",
            "address_2": "SUITE 6018B",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418232",
            "telephone_number": "314-251-5940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 S NEW BALLAS RD",
            "address_2": "SUITE 6018B",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418232",
            "telephone_number": "314-251-5940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLN",
        "first_name": "CHARLES",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-03",
        "last_updated": "2012-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": "MO",
            "license": "2004016664",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208364901",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.