NPIMap

Organization Active NPI

Fairview Heights Medical Group SC

  • Multi-Specialty Clinic/Center
  • Saint Louis, MO
National Provider Identifier
1679503668
Registry record updated Sep 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
FAIRVIEW HEIGHTS MEDICAL GROUP SC
Practice address
670 Mason Ridge Center Dr Ste 300
Saint Louis, MO 63141-8573
Phone
(314) 996-7644
Fax
(314) 996-7658
NPI assigned
Jul 4, 2006
Last updated
Sep 17, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2025

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

Authorized official

Name
Karen Canter-Koester
Title
VP Operations and Strategy
Phone
(314) 996-7610

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary
Medical Specialty Clinic/Center 261QM2500X
Primary Care Clinic/Center 261QP2300X

Addresses

Primary practice location

670 Mason Ridge Center Dr Ste 300
Saint Louis, MO 63141-8573

Mailing address

670 Mason Ridge Center Dr
Ste 300
Saint Louis, MO 63141-8573
Phone (314) 996-7644

Other identifiers 1

IdentifierTypeStateIssuer
500720107MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040309000650 IL Part B Supplier - Clinic/Group Practice 6800784083 Receives reassigned benefits from 526 practitioners
2 other NPIs on this enrollment
Practice locations: Shiloh, IL; Bethalto, IL; Collinsville, IL; Columbia, IL; Edwardsville, IL; Godfrey, IL; Maryville, IL; O Fallon, IL…
O20060302000596 MO Part B Supplier - Clinic/Group Practice 6800784083 Receives reassigned benefits from 135 practitioners
Practice locations: Saint Peters, MO; Saint Louis, MO; Florissant, MO; O Fallon, MO

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations (25 of 52)

1 Memorial Dr
#2101
Alton, IL 62002

1 Memorial Dr
Fl 1
Alton, IL 62002
Phone (618) 433-7066

2 Memorial Dr
Ste 105
Alton, IL 62002
Phone (618) 462-3191

2 Memorial Dr
Ste 200
Alton, IL 62002

3 Memorial Dr
Ste 101
Alton, IL 62002

4 Memorial Dr
Ste 130
Alton, IL 62002
Phone (618) 463-7600

4 Memorial Dr
Ste 203
Alton, IL 62002

4 Memorial Dr
Ste 230B
Alton, IL 62002
Phone (618) 463-7874

130 Lincoln Place Ct
Ste 130
Belleville, IL 62221
Phone (618) 257-1297

4500 Memorial Dr
#2114
Belleville, IL 62226

4500 Memorial Dr
Ste 100
Belleville, IL 62226

4500 Memorial Dr
Ste 280
Belleville, IL 62226
Phone (618) 277-3109

4500 Memorial Dr
Ste W1
Belleville, IL 62226

4600 Memorial Dr
Ste 210
Belleville, IL 62226

4600 Memorial Dr
Ste 220
Belleville, IL 62226
Phone (618) 222-8705

4600 Memorial Dr
Ste 250
Belleville, IL 62226

4600 Memorial Dr
Ste 260
Belleville, IL 62226
Phone (618) 257-4100

4700 Memorial Dr
Ste 250
Belleville, IL 62226
Phone (618) 212-6560

4700 Memorial Dr
Ste 300
Belleville, IL 62226
Phone (618) 234-9884

155 E Bethalto Dr
Bethalto, IL 62010
Phone (618) 377-8961

155 E Bethalto Dr
#B
Bethalto, IL 62010

565 E Bethalto Dr
Bethalto, IL 62010

9515 Holy Cross Ln
Ste 113
Breese, IL 62230
Phone (618) 526-1453

1095 Belt Line Rd
Collinsville, IL 62234

200 Admiral Trost Rd
Columbia, IL 62236
Phone (618) 281-7373

Practitioners & affiliated clinicians

Practitioners 713

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 713

NPI Registry JSON

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758067200000",
    "number": "1679503668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "670 MASON RIDGE CENTER DR",
            "address_2": "STE 300",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418573",
            "telephone_number": "314-996-7644",
            "fax_number": "314-996-7658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "670 MASON RIDGE CENTER DR STE 300",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418573",
            "telephone_number": "314-996-7644",
            "fax_number": "314-996-7658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRVIEW HEIGHTS MEDICAL GROUP SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-04",
        "last_updated": "2025-09-17",
        "certification_date": "2025-09-17",
        "status": "A",
        "authorized_official_last_name": "CANTER-KOESTER",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "VP OPERATIONS AND STRATEGY",
        "authorized_official_telephone_number": "314-996-7610"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500720107",
            "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 Sep 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.