Active NPI
Khalida Qalbani, MD
- Family Medicine Physician
- Saint Louis, MO
National Provider Identifier
1659322287
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 2004002967
- Practice address
- 5535 Delmar Boulevard
Saint Louis, MO 63112-3005 - Phone
- (314) 361-2273
- Fax
- (314) 879-6372
- NPI assigned
- May 16, 2006
- Last updated
- Dec 16, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 2004002967 | MO | Primary |
Addresses
Primary practice location
5535 Delmar Boulevard
Saint Louis, MO 63112-3005
Mailing address
5535 Delmar Boulevard
Saint Louis Connectcare
Saint Louis, MO 63112-3005
Phone (314) 879-6309
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 209353903 | Medicaid | MO | |
| 11462947 | Medicaid | MO |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140627001215 | MO | Order and Referring Only - Family Practice | 5395797484 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2004002967 | MO | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Saint Louis Connectcare | Past | Accepting new patients |
Organizations & group practices 1
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.
-
dba St. Louis ConnectCare Endoscopy Center
- Endoscopy Clinic/Center
- Saint Louis, MO
- NPI 1679797237
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147737600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323993600000",
"number": "1659322287",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5535 DELMAR BOULEVARD",
"address_2": "SAINT LOUIS CONNECTCARE",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631123005",
"telephone_number": "314-879-6309",
"fax_number": "314-879-6372"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5535 DELMAR BOULEVARD",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631123005",
"telephone_number": "314-361-2273",
"fax_number": "314-879-6372"
}
],
"practiceLocations": [],
"basic": {
"last_name": "QALBANI",
"first_name": "KHALIDA",
"name_prefix": "Mrs.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-16",
"last_updated": "2011-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MO",
"license": "2004002967",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "209353903",
"state": "MO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "11462947",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.