Eden Pediatrics LLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD101423 Issued in MO

Legal business name

EDEN PEDIATRICS LLC

Practice address

763 S New Ballas Rd
Suite 220
Saint Louis, MO 63141-8704

Phone

(314) 983-0606

Fax

(314) 983-0608

NPI assigned

Sep 15, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Etihad Shakir Al-Falahi, M.DNPI 1831205327

Title

President

Phone

(314) 983-0606

Specialties & licenses 1

Addresses

Other identifiers 6

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Etihad Shakir Alfalahi, M.D.

  • Pediatrics Physician
  • Saint Louis, MO
  • NPI 1831205327
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1659477024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "763 S NEW BALLAS RD STE 220",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418711",
            "telephone_number": "314-983-0606",
            "fax_number": "314-983-0608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "763 S NEW BALLAS RD",
            "address_2": "SUITE 220",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418704",
            "telephone_number": "314-983-0606",
            "fax_number": "314-983-0608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDEN PEDIATRICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "AL-FALAHI",
        "authorized_official_first_name": "ETIHAD",
        "authorized_official_middle_name": "SHAKIR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "314-983-0606",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "MD101423",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "114721",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5013620",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "286120",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MERCY HEALTH PLAN",
            "identifier": "G10654",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "1210150",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP HEALTH PLAN",
            "identifier": "214028",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Adam J Edelman, M.D.
• Tracy Lynn Edelmann, D.C.
• Brian Todd Edelson, M.D., PH.D.
• Sean Lewis Edelstein, MD
• Eden Manor LLC
• Edens Sacred Hand Homecare, LLC
• Stacey Lynn Ederer
• Julia D Edgar, MA
• Randall C Edgell, MD
• Tyler I Edgerton

• Pediatrics Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Pediatrics Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.