Individual provider Active NPI

Robyn Leith Haithcock Sr., DO

  • Gastroenterology Physician
  • Hazelwood, MO
National Provider Identifier
1497751994
Registry record updated Oct 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
105736 Issued in MO
Practice address
100 Village SQ
Hazelwood, MO 63042-1820
Phone
(314) 355-4010
Fax
(314) 355-9484
NPI assigned
Jun 21, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 105736 MO Primary

Addresses

Primary practice location

100 Village SQ
Hazelwood, MO 63042-1820

Mailing address

PO Box 23340
Saint Louis, MO 63156-3340
Phone (314) 851-1000

Other identifiers 1

IdentifierTypeStateIssuer
246971709MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20181211000364 IL Practitioner - GastroenterologyPractitioner - Internal Medicine 0547266496 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
Oklahoma State University College of Osteopathic Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Touchette Regional Hospital IncGroup PAC ID 7416843370, 46 clinicians

Practice addresses (Care Compare)

2071 Goose Lake Rd
Sauget, IL 62206-2822
Phone (618) 857-2700

5900 Bond Ave
Cahokia Heights, IL 62207-2326
Phone (618) 332-3060

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.37 of 100Reported as group
Quality
79.66
Promoting interoperability
98
Improvement activities
40
Cost
76.57

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy17
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Touchette Regional Hospital Inc CurrentSince Oct 27, 2018 Accepting new patients

Locations

180 S 3rd St
Ste 351
Belleville, IL 62220
Phone (618) 213-7959

5900 Bond Ave
East Saint Louis, IL 62207
Phone (618) 332-3060

2071 Goose Lake Rd
Sauget, IL 62206
Phone (314) 872-1473

Interoperability endpoints

  • Direct secure messaging: robyn.haithcock.1@9559.direct.athenahealth.com
  • Direct secure messaging: robyn.haithcock.p1@direct.essehealth.nextgenshare.com

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.

Hospital & facility affiliations 3

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": "1119312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696982400000",
    "number": "1497751994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23340",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631563340",
            "telephone_number": "314-851-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 VILLAGE SQ",
            "city": "HAZELWOOD",
            "state": "MO",
            "postal_code": "630421820",
            "telephone_number": "314-355-4010",
            "fax_number": "314-355-9484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAITHCOCK",
        "first_name": "ROBYN",
        "middle_name": "LEITH",
        "name_suffix": "Sr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-21",
        "last_updated": "2023-10-11",
        "certification_date": "2023-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MO",
            "license": "105736",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "246971709",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hazelwood, MO

Sources for this page

Verify at the official NPI Registry.