Individual provider Active NPI

Dipika Menon, M.D

  • Pediatric Cardiology Physician
  • St Louis, MO
National Provider Identifier
1629483094
Registry record updated Apr 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Cardiology PhysicianTaxonomy code 2080P0202X
License
MD470052 Issued in PA
Practice address
1465 S Grand Blvd
Division of Pediatric Cardiology
St Louis, MO 63104
Phone
(314) 577-5633
Fax
(314) 268-4141
NPI assigned
Jun 24, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 12, 2022

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 57.024073 OH
Pediatric Cardiology Physician 2080P0202X MD470052 PA Primary

Addresses

Primary practice location

1465 S Grand Blvd
Division of Pediatric Cardiology
St Louis, MO 63104

Mailing address

10 Park Row W Apt 331
Providence, RI 02903-1172
Phone (248) 631-6672

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
I20220603000819 MO Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Pediatric MedicinePractitioner - Other (Physician) 3072881572 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Pediatric Medicine
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SSM Health Care GroupGroup PAC ID 0143608372, 929 clinicians

Practice addresses (Care Compare)

1465 S Grand Blvd
Saint Louis, MO 63104-1003
Phone (314) 577-5641

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.94 of 100Reported as group
Quality
68.52
Promoting interoperability
100
Improvement activities
40
Cost
72.22

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
57.024073OHMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
SSM Health Care Group Pediatrics CurrentSince Jul 1, 2022 Accepting new patients
SSM Health Care Group CurrentSince Jul 1, 2022 Accepting new patients
SSM Medical Group Inc. Past Accepting new patients
SSM Cardinal Glennon Children'S Hospital Past Accepting new patients

Locations

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

10101 Woodfield Ln
Saint Louis, MO 63132
Phone (608) 280-4647

Interoperability endpoints

  • Direct secure messaging: dmenon423546@direct-ehr-ssmhc.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 and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1403568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649721600000",
    "number": "1629483094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 PARK ROW W APT 331",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029031172",
            "telephone_number": "248-631-6672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1465 S GRAND BLVD",
            "address_2": "DIVISION OF PEDIATRIC CARDIOLOGY",
            "city": "ST LOUIS",
            "state": "MO",
            "postal_code": "63104",
            "telephone_number": "314-577-5633",
            "fax_number": "314-268-4141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENON",
        "first_name": "DIPIKA",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-06-24",
        "last_updated": "2022-04-12",
        "certification_date": "2022-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "57.024073",
            "primary": false
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "PA",
            "license": "MD470052",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Louis, MO

Sources for this page

Verify at the official NPI Registry.