NPIMap

Individual provider Active NPI

John T Ellena, MD

  • Internal Medicine Physician
  • Saint Louis, MO
National Provider Identifier
1487767240
Registry record updated Sep 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
36600 Issued in MO
Practice address
1040 N Mason Rd Ste 102
Saint Louis, MO 63141-6361
Phone
(314) 758-6053
NPI assigned
Aug 16, 2006
Last updated
Sep 25, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 36600 MO Primary

Addresses

Primary practice location

1040 N Mason Rd Ste 102
Saint Louis, MO 63141-6361

Mailing address

1040 N Mason Rd Ste 102
Saint Louis, MO 63141-6361
Phone (314) 758-6053

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
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080206000439 MO Practitioner - Internal Medicine 7618885898 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Southern Illinois University School of Medicine, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Physician Groups LCGroup PAC ID 3072421254, 526 clinicians

Practice addresses (Care Compare)

1110 Highlands Plaza Dr E
Saint Louis, MO 63110-1351
Phone (314) 273-0195

2630 Hwy K
O Fallon, MO 63368-6624
Phone (636) 240-5454

3015 N Ballas Rd
Saint Louis, MO 63131-2329
Phone (314) 996-5772

969 N Mason Rd
Suite 160
Saint Louis, MO 63141-6387
Phone (314) 758-6053

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Physician Groups LC Internal Medicine CurrentSince Nov 1, 2007 Accepting new patients
Physician Groups LC CurrentSince Oct 25, 2000 Accepting new patients
Fairview Heights Medical Group SC PastSince Jun 1, 2001 Accepting new patients
Ozarks Medical Center Past Accepting new patients
Missouri Baptist Hospital of Sullivan PastSince Feb 18, 2008 Accepting new patients

Locations

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

1040 N Mason Rd
Ste 102
Saint Louis, MO 63141
Phone (314) 758-6053

670 Mason Ridge Center Dr
Ste 300
Saint Louis, MO 63141
Phone (314) 996-7644

969 N Mason Rd
Ste 160
Saint Louis, MO 63141
Phone (314) 434-8828

Interoperability endpoints

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

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

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": "1155686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758758400000",
    "number": "1487767240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 N MASON RD STE 102",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631416361",
            "telephone_number": "314-758-6053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 N MASON RD STE 102",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631416361",
            "telephone_number": "314-758-6053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLENA",
        "first_name": "JOHN",
        "middle_name": "T",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-16",
        "last_updated": "2025-09-25",
        "certification_date": "2025-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "36600",
            "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": "1040 N Mason Rd Ste 102",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631416361",
            "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.