Active NPI
Roger Waxelman, M.D.
- Emergency Medicine Physician
- Florissant, MO
National Provider Identifier
1487679882
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 32436
- Practice address
- 1225 Graham Rd
Florissant, MO 63031-8014 - Phone
- (314) 953-6000
- NPI assigned
- Jul 13, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 036-104350 | IL | |
| Emergency Medicine Physician | 207P00000X | 32436 | MO | Primary |
Addresses
Primary practice location
1225 Graham Rd
Florissant, MO 63031-8014
Mailing address
75 Remit Drive
Lockbox 6804
Chicago, IL 60675-6804
Phone (866) 916-5259
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 498464982-2 | Medicaid | IL | |
| 498464982-1 | Medicaid | IL | |
| 200856011 | Medicaid | MO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-104350 | IL | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North County Emergency Physicians, LLP | Emergency Medicine | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Emergency Medicine Physician
- Florissant, MO
- NPI 1356366934
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": "1234828800000",
"number": "1487679882",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "75 REMIT DRIVE",
"address_2": "LOCKBOX 6804",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606756804",
"telephone_number": "866-916-5259",
"fax_number": "231-922-4030"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1225 GRAHAM RD",
"city": "FLORISSANT",
"state": "MO",
"postal_code": "630318014",
"telephone_number": "314-953-6000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAXELMAN",
"first_name": "ROGER",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-13",
"last_updated": "2009-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "IL",
"license": "036-104350",
"primary": false
},
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "MO",
"license": "32436",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "498464982-2",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "498464982-1",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200856011",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Florissant, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.