NPIMap

Individual provider Active NPI

Jambunathan Mahadevan, MD

  • Internal Medicine Physician
  • Saint Louis, MO
National Provider Identifier
1669588638
Registry record updated Aug 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
R7375 Issued in MO
Practice address
3535 S Jefferson Ave
Suite 304
St Louis, MO 63118
Phone
(314) 865-6585
Fax
(314) 865-6599
NPI assigned
Aug 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2010

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 R7375 MO Primary

Addresses

Primary practice location

3535 S Jefferson Ave
Suite 304
St Louis, MO 63118

Mailing address

PO Box 775578
St Louis, MO 63177-5578
Phone (314) 865-6582

Other identifiers 3

IdentifierTypeStateIssuer
201582608MedicaidMO
0400415OtherMOUHC
100656OtherMOBLUE SHIELD

Other names 1

  • Jay Mahadevan Other name

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
I20100920000972 MO Practitioner - Internal Medicine 1456476043 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1971
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

11222 Tesson Ferry Rd
Suite 102
Saint Louis, MO 63123-6963
Phone (314) 865-6585

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R7375MOMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jay Mahadevan Inc Internal Medicine CurrentSince Dec 31, 1991 Accepting new patients

Locations

3535 S Jefferson Ave
Ste 304
Saint Louis, MO 63118
Phone (314) 771-0677

7220 Watson Rd
Saint Louis, MO 63119
Phone (314) 352-5500

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.

Hospital & facility affiliations 6

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": "1156204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280966400000",
    "number": "1669588638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 775578",
            "city": "ST LOUIS",
            "state": "MO",
            "postal_code": "631775578",
            "telephone_number": "314-865-6582",
            "fax_number": "314-865-6599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 S JEFFERSON AVE",
            "address_2": "SUITE 304",
            "city": "ST LOUIS",
            "state": "MO",
            "postal_code": "63118",
            "telephone_number": "314-865-6585",
            "fax_number": "314-865-6599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHADEVAN",
        "first_name": "JAMBUNATHAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-22",
        "last_updated": "2010-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "R7375",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201582608",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC",
            "identifier": "0400415",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "100656",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JAY",
            "last_name": "MAHADEVAN",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.