Individual provider Active NPI

Geetha Maddukuri, M.D.

  • Internal Medicine Physician
  • Saint Louis, MO
National Provider Identifier
1508022344
Registry record updated Apr 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2010006698 Issued in MO
Practice address
915 N Grand Blvd
Saint Louis, MO 63106-1621
Phone
(636) 697-5415
Fax
(636) 697-5415
NPI assigned
Jul 31, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2024

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 2010006698 MO Primary

Addresses

Primary practice location

915 N Grand Blvd
Saint Louis, MO 63106-1621

Mailing address

915 N Grand Blvd
Saint Louis, MO 63106-1621
Phone (636) 697-5415

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
I20100701000736 MO Practitioner - Internal Medicine 7416088679 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2010006698MOMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Physician Specialists of St Lukes LLC Internal Medicine CurrentSince Feb 18, 2015 Accepting new patients

Locations

121 Saint Lukes Center Dr
Chesterfield, MO 63017
Phone (314) 434-3278

232 S Woods Mill Rd
Town and Country, MO 63017
Phone (314) 205-6030

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.

NPI Registry JSON

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

{
    "created_epoch": "1217462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713916800000",
    "number": "1508022344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 N GRAND BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631061621",
            "telephone_number": "636-697-5415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 N GRAND BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631061621",
            "telephone_number": "636-697-5415",
            "fax_number": "636-697-5415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MADDUKURI",
        "first_name": "GEETHA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-31",
        "last_updated": "2024-04-24",
        "certification_date": "2024-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2010006698",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.