NPIMap

Individual provider Active NPI

Damon C Clines, M.D.

  • Gastroenterology Physician
  • Saint Louis, MO
National Provider Identifier
1508800582
Registry record updated Nov 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
107492 Issued in MO
Practice address
4510 Delmar Blvd
Saint Louis, MO 63108-1702
Phone
(314) 454-6903
Fax
(314) 454-6652
NPI assigned
Jun 16, 2006
Last updated
Nov 13, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 13, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 107492 MO Primary
Gastroenterology Physician 207RG0100X 036-092178 IL

Addresses

Primary practice location

4510 Delmar Blvd
Saint Louis, MO 63108-1702

Mailing address

4510 Delmar Blvd
Saint Louis, MO 63108-1702
Phone (314) 454-6903

Other identifiers 2

IdentifierTypeStateIssuer
P00156563OtherMORR MEDICARE
208107912MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, MO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040629000629 IL Practitioner - Gastroenterology 9739163197 Reassigns benefits to 1 organization
I20040721000314 MO Practitioner - Internal MedicinePractitioner - Gastroenterology 9739163197 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
University of Missouri, Columbia School of Medicine, 1983
Medicare assignment
May accept Medicare assignment
Group practices
Ahs Il Medical Group LLCGroup PAC ID 5496111676, 46 clinicians

Practice addresses (Care Compare)

2044 Madison Ave
Suite 27
Granite City, IL 62040-4661
Phone (618) 451-7600

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy18
Upper gastrointestinal (GI) endoscopy for acid reflux16

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-092178ILMDGastroenterology Physician
107492MOMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
KND Development 59, LLC Current Accepting new patients
Central West End Endoscopy LLC CurrentSince Sep 25, 2000 Accepting new patients
KND Development 59, LLC CurrentSince Aug 1, 2018 Accepting new patients
Southeast Missouri Hospital Physicians, LLC Gastroenterology CurrentSince Oct 8, 2014 Accepting new patients
Ahs Il Medical Group LLC CurrentSince Feb 10, 2025 Accepting new patients
KND Development 59, LLC CurrentSince Aug 1, 2018 Accepting new patients

Locations

1 Saint Anthonys Way
Alton, IL 62002
Phone (618) 233-6870

2044 Madison Ave
Ste 27
Granite City, IL 62040
Phone (618) 451-0700

2100 Madison Ave
Granite City, IL 62040
Phone (618) 798-3000

2100 Madison Ave
Ste 301
Granite City, IL 62040

8 Doctors Park Rd
Mount Vernon, IL 62864
Phone (618) 244-5500

1701 Lacey St
Cpe Girardeau, MO 63701
Phone (573) 334-4822

10018 Kennerly Rd
Fl 3
Saint Louis, MO 63128
Phone (314) 361-8100

4510 Delmar Blvd
Saint Louis, MO 63108
Phone (314) 303-6465

Interoperability endpoints

  • Direct secure messaging: damon.clines.1@28328.direct.athenahealth.com

Organizations & group practices 6

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 7

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": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731456000000",
    "number": "1508800582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4510 DELMAR BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631081702",
            "telephone_number": "314-454-6903",
            "fax_number": "314-454-6652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4510 DELMAR BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631081702",
            "telephone_number": "314-454-6903",
            "fax_number": "314-454-6652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLINES",
        "first_name": "DAMON",
        "middle_name": "C",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-16",
        "last_updated": "2024-11-13",
        "certification_date": "2024-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MO",
            "license": "107492",
            "primary": true
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "IL",
            "license": "036-092178",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00156563",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208107912",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.