NPIMap

Individual provider Active NPI

Sidharth Venkata Puram, MD

  • Otolaryngology Physician
  • Saint Louis, MO
National Provider Identifier
1568800183
Registry record updated Apr 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
2019011642 Issued in MO
Practice address
4500 Forest Park Ave
Dept Otolaryngology, 5TH FL
Saint Louis, MO 63108-2114
Phone
(314) 362-7509
Fax
(888) 452-4025
NPI assigned
Jun 5, 2013
Sex
Male
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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 2019011642 MO Primary

Addresses

Primary practice location

4500 Forest Park Ave
Dept Otolaryngology, 5TH FL
Saint Louis, MO 63108-2114

Mailing address

PO Box 7412011
Chicago, IL 60674-2011
Phone (314) 362-7509

Other identifiers 1

IdentifierTypeStateIssuer
200068596MedicaidMO

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
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190521000913 MO Practitioner - Otolaryngology 3971732652 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Harvard Medical School, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Washington UniversityGroup PAC ID 9830008770, 2,968 clinicians

Practice addresses (Care Compare)

660 S Euclid Ave Box
8115 Dept of Otolaryngology
Saint Louis, MO 63110-1010
Phone (314) 362-7509

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.2 of 100Reported as group
Quality
71.6
Promoting interoperability
100
Improvement activities
40
Cost
75.75

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper gastrointestinal (GI) endoscopy for acid reflux18
Melanoma (skin cancer) excision13
Removal of tissue1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2019011642MOMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Washington University CurrentSince Jul 1, 2019 Accepting new patients
Washington University CurrentSince Jul 1, 2019 Accepting new patients
Washington University Past Accepting new patients
Ozarks Medical Center Otolaryngology Past Accepting new patients
Barnes Jewish Hospital Past Accepting new patients

Locations

4921 Parkview Pl
Ste 11A
Saint Louis, MO 63110
Phone (314) 362-7489

660 S Euclid Ave
#8115
Saint Louis, MO 63110
Phone (314) 362-7395

1 Barnes Hospital Plz
Saint Louis, MO 63110
Phone (314) 362-9170

4500 Forest Park Ave
Fl 5
Saint Louis, MO 63108

Interoperability endpoints

  • Direct secure messaging: spuram999964@direct.carenet.org
  • FHIR API: https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

Organizations & group practices 5

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 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": "1370390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744848000000",
    "number": "1568800183",
    "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": "314-362-7509",
            "fax_number": "888-452-4025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 FOREST PARK AVE",
            "address_2": "DEPT OTOLARYNGOLOGY, 5TH FL",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631082114",
            "telephone_number": "314-362-7509",
            "fax_number": "888-452-4025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PURAM",
        "first_name": "SIDHARTH",
        "middle_name": "VENKATA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-05",
        "last_updated": "2025-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "MO",
            "license": "2019011642",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200068596",
            "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": "4500 Forest Park Ave",
            "address_2": "Dept Otolaryngology, 5th Fl",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631082114",
            "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.