NPIMap

Individual provider Active NPI

Lissa Lopez-Concagh, MD

  • Nephrology Physician
  • Saint Louis, MO
National Provider Identifier
1619957917
Registry record updated Dec 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
108606 Issued in MO
Practice address
450 N New Ballas Rd Ste 204
Saint Louis, MO 63141-6836
Phone
(314) 991-0137
Fax
(314) 991-0603
NPI assigned
Jan 20, 2006
Last updated
Dec 22, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 108606 MO Primary

Addresses

Primary practice location

450 N New Ballas Rd Ste 204
Saint Louis, MO 63141-6836

Mailing address

PO Box 840185
Kansas City, MO 64184-0185
Phone (314) 991-0137

Other identifiers 1

IdentifierTypeStateIssuer
205957517MedicaidMO

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
I20040304000503 MO Practitioner - NephrologyPractitioner - Internal Medicine 6406743269 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
University of Puerto Rico School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Elite Physical Therapy of Creve Coeur LLCGroup PAC ID 7719280841, 85 clinicians

Practice addresses (Care Compare)

12788 Olive Blvd
Creve Coeur, MO 63141-6211

450 N New Ballas Rd
Suite 204
Saint Louis, MO 63141-6836
Phone (314) 991-0137

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Nephrology and Hypertension Specialists, LLC Nephrology CurrentSince Apr 1, 2004 Accepting new patients
Nephrology and Hypertension Specialists, LLC Nephrology CurrentSince Dec 24, 2023 Accepting new patients
Inpatient Consultants of Missouri Inc Past Accepting new patients

Locations

828 E High St
Ste 2
Potosi, MO 63664
Phone (573) 436-0723

450 N New Ballas Rd
Ste 204
Saint Louis, MO 63141
Phone (314) 991-0137

10004 Kennerly Rd
Ste 374B
Saint Louis, MO 63128
Phone (314) 294-9210

3009 N Ballas Rd
Ste 365
Saint Louis, MO 63131
Phone (314) 843-3449

3009 N Ballas Rd
Ste 365C
Saint Louis, MO 63131
Phone (314) 991-0137

Interoperability endpoints

  • Direct secure messaging: llopezconcagh16666@direct-ehr-ssmhc.com
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: lissam.lopezconcagh.p1@direct.nephrologyhtn.nextgenshare.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1137715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703203200000",
    "number": "1619957917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 840185",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641840185",
            "telephone_number": "314-991-0137",
            "fax_number": "314-991-0603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 N NEW BALLAS RD STE 204",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631416836",
            "telephone_number": "314-991-0137",
            "fax_number": "314-991-0603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOPEZ-CONCAGH",
        "first_name": "LISSA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-20",
        "last_updated": "2023-12-22",
        "certification_date": "2023-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "MO",
            "license": "108606",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "205957517",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.