NPIMap

Individual provider Active NPI

Moyosore Kikelomo Onifade, M.D.

  • Internal Medicine Physician
  • Saint Louis, MO
National Provider Identifier
1669586954
Registry record updated Jun 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2002019255 Issued in MO
Practice address
2880 Netherton Dr Ste 200
Saint Louis, MO 63136-4697
Phone
(636) 333-4500
Fax
(314) 521-4656
NPI assigned
Aug 17, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 19, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 2002019255 MO Primary

Addresses

Primary practice location

2880 Netherton Dr Ste 200
Saint Louis, MO 63136-4697

Mailing address

2880 Netherton Dr Ste 200
Saint Louis, MO 63136-4697
Phone (636) 333-4500

Other identifiers 1

IdentifierTypeStateIssuer
208818716MedicaidMO

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
I20041108001081 MO Practitioner - Internal Medicine 5193628881 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Washington University School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2880 Netherton Dr
Suite 200
Saint Louis, MO 63136-4697
Phone (314) 355-5300

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2002019255MOMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dr. M. K. Onifade Internal Medicine Practice LLC Internal Medicine CurrentSince Jun 24, 2004 Accepting new patients
Christian Hospital Northeast- Northwest PastSince Jan 1, 2026 Accepting new patients
Midwest Acute Care Consultants, PC Past Accepting new patients

Locations

2880 Netherton Dr
Ste 200
Saint Louis, MO 63136
Phone (314) 355-5300

Interoperability endpoints

  • Direct secure messaging: monifade135669@direct.carenet.org
  • FHIR API: https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Christian Hospital Northeast NorthwestSaint Louis, MO, CCN 260180 Hospital Corporate Director Jan 1, 2026
Christian HospitalSaint Louis, MO, CCN 26T180 Hospital Corporate Director Jan 1, 2026

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

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 5

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": "1155772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718755200000",
    "number": "1669586954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2880 NETHERTON DR STE 200",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631364697",
            "telephone_number": "636-333-4500",
            "fax_number": "314-521-4656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2880 NETHERTON DR STE 200",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631364697",
            "telephone_number": "636-333-4500",
            "fax_number": "314-521-4656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ONIFADE",
        "first_name": "MOYOSORE",
        "middle_name": "KIKELOMO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-17",
        "last_updated": "2024-06-19",
        "certification_date": "2024-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2002019255",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208818716",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.