NPIMap

Organization Active NPI

Ambulatory Anesthesia Services of St. Charles, LLC

  • Anesthesiology Physician
  • Saint Peters, MO
National Provider Identifier
1467634097
Registry record updated Dec 7, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
AMBULATORY ANESTHESIA SERVICES OF ST. CHARLES, LLC
Practice address
4203 S Cloverleaf Dr
Saint Peters, MO 63376-6452
Phone
(636) 346-6051
NPI assigned
Dec 5, 2007
Last updated
Dec 7, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2007

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

Authorized official

Name
Dr. Krishna Kanakadandila, M.D.NPI 1972584738
Title
Manager
Phone
(636) 346-6051

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X NU Primary

Addresses

Primary practice location

4203 S Cloverleaf Dr
Saint Peters, MO 63376-6452

Mailing address

13523 Barrett Parkway Dr
Suite 210
Ballwin, MO 63021-3802
Phone (314) 775-2816

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080121000079 MO Part B Supplier - Clinic/Group Practice 3173604782 Receives reassigned benefits from 44 practitioners
Practice locations: Saint Peters, MO

National Provider Directory

National Provider Directory

Locations

13523 Barrett Parkway Dr
Ste 210
Ballwin, MO 63021

Practitioners & affiliated clinicians

Practitioners 47

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 47

NPI Registry JSON

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

{
    "created_epoch": "1196812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196985600000",
    "number": "1467634097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13523 BARRETT PARKWAY DR",
            "address_2": "SUITE 210",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630213802",
            "telephone_number": "314-775-2816",
            "fax_number": "314-775-2821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4203 S CLOVERLEAF DR",
            "city": "SAINT PETERS",
            "state": "MO",
            "postal_code": "633766452",
            "telephone_number": "636-346-6051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMBULATORY ANESTHESIA SERVICES OF ST. CHARLES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-05",
        "last_updated": "2007-12-07",
        "status": "A",
        "authorized_official_last_name": "KANAKADANDILA",
        "authorized_official_first_name": "KRISHNA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "636-346-6051",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Peters, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.