Individual provider Active NPI

Diliane Charles Pelikan, MD

  • Pediatric Emergency Medicine (Pediatrics) Physician
  • Florissant, MO
National Provider Identifier
1508811787
Registry record updated Apr 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Emergency Medicine (Pediatrics) PhysicianTaxonomy code 2080P0204X
License
117876 Issued in MO
Practice address
1225 Graham Rd
Div Ped Emergency Med
Florissant, MO 63031-8012
Phone
(314) 454-2341
Fax
(314) 454-4345
NPI assigned
May 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 117876 MO
Pediatric Emergency Medicine (Pediatrics) Physician 2080P0204X 117876 MO Primary

Addresses

Primary practice location

1225 Graham Rd
Div Ped Emergency Med
Florissant, MO 63031-8012

Mailing address

PO Box 7412011
Chicago, IL 60674-2011
Phone (314) 454-2341

Other identifiers 1

IdentifierTypeStateIssuer
208983817MedicaidMO

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Washington University

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
I20050222000032 MO Practitioner - Emergency MedicinePractitioner - Pediatric Medicine 3870546682 Reassigns benefits to 3 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Washington University CurrentSince Jul 1, 2018 Accepting new patients
Washington University CurrentSince Jul 1, 2018 Accepting new patients
Mercy Hospitals East Communities CurrentSince Aug 1, 2016 Accepting new patients
Southeastern Emergency Physicians of Memphis LLC CurrentSince Aug 23, 2014 Accepting new patients

Locations

1600 E Broadway
Columbia, MO 65201
Phone (573) 632-5000

1225 Graham Rd
Florissant, MO 63031
Phone (314) 653-5630

11133 Dunn Rd
Saint Louis, MO 63136
Phone (314) 653-5000

1465 S Grand Blvd
Saint Louis, MO 63104
Phone (314) 268-4070

1 Childrens Pl
#1230
Saint Louis, MO 63110

1 Childrens Pl
Ste C
Saint Louis, MO 63110
Phone (314) 454-2104

1 Childrens Pl
Saint Louis, MO 63110
Phone (314) 454-2076

615 S New Ballas Rd
Saint Louis, MO 63141
Phone (314) 251-4687

1 Childrens Pl
#8116
Saint Louis, MO 63110
Phone (314) 454-6095

Interoperability endpoints

  • Direct secure messaging: dpelikan134250@direct.carenet.org

Organizations & group practices 4

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": "1148428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744848000000",
    "number": "1508811787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7412011",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606742011",
            "telephone_number": "314-454-2341",
            "fax_number": "314-454-4345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 GRAHAM RD",
            "address_2": "DIV PED EMERGENCY MED",
            "city": "FLORISSANT",
            "state": "MO",
            "postal_code": "630318012",
            "telephone_number": "314-454-2341",
            "fax_number": "314-454-4345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PELIKAN",
        "first_name": "DILIANE",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-24",
        "last_updated": "2025-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "117876",
            "primary": false
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "MO",
            "license": "117876",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208983817",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "1225 Graham Rd",
            "address_2": "Div Ped Emergency Med",
            "city": "Florissant",
            "state": "MO",
            "country_code": "US",
            "postal_code": "630318012",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Florissant, MO

Sources for this page

Verify at the official NPI Registry.