NPIMap

Individual provider Active NPI

Robert G Lutan, MD

  • Cardiovascular Disease Physician
  • Saint Louis, MO
National Provider Identifier
1528051422
Registry record updated Mar 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
101315 Issued in MO
Practice address
11125 Dunn Rd
Suite 204
Saint Louis, MO 63136-6132
Phone
(314) 839-5522
Fax
(314) 839-5351
NPI assigned
Aug 25, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 036085097 IL
Cardiovascular Disease Physician 207RC0000X 101315 MO Primary

Addresses

Primary practice location

11125 Dunn Rd
Suite 204
Saint Louis, MO 63136-6132

Mailing address

11125 Dunn Rd
Suite 204
Saint Louis, MO 63136-6132
Phone (314) 839-5522

Other practice location 1

12255 De Paul Dr Ste 600
Bridgeton, MO 63044-2515
Phone (314) 770-9888

Other identifiers 13

IdentifierTypeStateIssuer
0360850972MedicaidIL
060065494OtherMORRMCR
060065495OtherILILRRMCR
177033OtherHLNK
2500837OtherUHC
4243966OtherAETNA
5386951007OtherCIGNA
12857V3831OtherGHP/CMR
205722705MedicaidMO
34842V8816OtherHCUSA
F04428OtherMERCY
149885OtherMOMOBS/BLCHOICE
98151V30946OtherHLTHPART

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address rlutan22826@direct-ehr-ssmhc.com Direct
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Health Information Exchange (HIE) Alton Memorial Hospital

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, IL2 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
I20061114000146 MO Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal MedicinePractitioner - Nuclear Medicine 3274531934 Reassigns benefits to 2 organizations
I20101020000532 IL Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 3274531934 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
University of Texas Medical School at San Antonio, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Alton Memorial Physician Billing Services LLCGroup PAC ID 9436389442, 11 clinicians
Christian Hospital Physician Billing Services LLCGroup PAC ID 4284796913, 11 clinicians

Practice addresses (Care Compare)

1 Memorial Dr Administration
Alton, IL 62002-6722

11125 Dunn Rd
Suite 204
Saint Louis, MO 63136-6188
Phone (314) 839-5522

2 Memorial Dr
Suite 122
Alton, IL 62002-6723
Phone (618) 462-6612

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Pacemaker insertion or repair30

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
101315MOMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Osf Healthcare System CurrentSince Nov 1, 2014 Accepting new patients
Alton Memorial Physician Billing Services LLC CurrentSince Nov 1, 2019 Accepting new patients
Christian Hospital Physician Billing Services LLC Cardiovascular Disease CurrentSince Nov 1, 2019 Accepting new patients
SSM Medical Group, Inc. Cardiovascular Disease CurrentSince Jul 24, 2018 Accepting new patients
SSM Depaul Medical Group, Inc. Past Accepting new patients
St Louis Cardiology Consultants LTD Cardiovascular Disease Past Accepting new patients
Saint Anthony's Physician Group Past Accepting new patients
Alton Memorial Physician Billing Services, LLC Past Accepting new patients

Locations

1 Memorial Dr
Alton, IL 62002
Phone (618) 463-7240

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

2 Memorial Dr
Ste 220
Alton, IL 62002
Phone (618) 462-6200

2 Memorial Dr
Ste 102
Alton, IL 62002
Phone (618) 288-0900

2 Memorial Dr
Ste 122
Alton, IL 62002
Phone (618) 462-6612

124 SW Adams St
Peoria, IL 61602
Phone (309) 655-2850

12255 De Paul Dr
Ste 600
Bridgeton, MO 63044
Phone (314) 209-5100

3221 McKelvey Rd
Ste 301
Bridgeton, MO 63044

14021 New Halls Ferry Rd
Florissant, MO 63033
Phone (314) 839-0910

1475 Kisker Rd
Ste 200
Saint Charles, MO 63304
Phone (636) 498-5800

11125 Dunn Rd
Ste 204
Saint Louis, MO 63136
Phone (314) 355-2300

1035 Bellevue Ave
Ste 500
Saint Louis, MO 63117
Phone (314) 647-1115

11133 Dunn Rd
Ste 2346
Saint Louis, MO 63136
Phone (314) 653-5125

Interoperability endpoints

  • Direct secure messaging: rlutan22826@direct-ehr-ssmhc.com
  • FHIR API: https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
  • Direct secure messaging: rlutan135094@direct.carenet.org

Organizations & group practices 10

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 6

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": "1124928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648425600000",
    "number": "1528051422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11125 DUNN RD",
            "address_2": "SUITE 204",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631366132",
            "telephone_number": "314-839-5522",
            "fax_number": "314-839-5351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11125 DUNN RD",
            "address_2": "SUITE 204",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631366132",
            "telephone_number": "314-839-5522",
            "fax_number": "314-839-5351"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12255 De Paul Dr Ste 600",
            "address_purpose": "LOCATION",
            "city": "Bridgeton",
            "state": "MO",
            "postal_code": "630442515",
            "country_code": "US",
            "telephone_number": "314-770-9888",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LUTAN",
        "first_name": "ROBERT",
        "middle_name": "G",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-25",
        "last_updated": "2022-03-28",
        "certification_date": "2022-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IL",
            "license": "036085097",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MO",
            "license": "101315",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0360850972",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MORRMCR",
            "identifier": "060065494",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ILRRMCR",
            "identifier": "060065495",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HLNK",
            "identifier": "177033",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC",
            "identifier": "2500837",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4243966",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "5386951007",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHP/CMR",
            "identifier": "12857V3831",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "205722705",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HCUSA",
            "identifier": "34842V8816",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MERCY",
            "identifier": "F04428",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MOBS/BLCHOICE",
            "identifier": "149885",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HLTHPART",
            "identifier": "98151V30946",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rlutan22826@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "rlutan22826@direct-ehr-ssmhc.com",
            "address_1": "12255 De Paul Dr Ste 600",
            "city": "Bridgeton",
            "state": "MO",
            "country_code": "US",
            "postal_code": "630442515",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "12255 De Paul Dr Ste 600",
            "city": "Bridgeton",
            "state": "MO",
            "country_code": "US",
            "postal_code": "630442515",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "endpointDescription": "BJC",
            "affiliationName": "Alton Memorial Hospital",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1 Memorial Dr",
            "city": "Alton",
            "state": "IL",
            "country_code": "US",
            "postal_code": "620026722",
            "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.