Individual provider Active NPI

Sean Lewis Edelstein, MD

  • Ophthalmology Physician
  • Saint Louis, MO
National Provider Identifier
1679520605
Registry record updated Jan 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
2005019369 Issued in MO
Practice address
1225 S Grand Blvd
Saint Louis, MO 63104-1016
Phone
(314) 977-5200
Fax
(314) 977-9910
NPI assigned
May 27, 2006
Last updated
Jan 19, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 2005019369 MO
Internal Medicine Physician 207R00000X 2005019369 MO
Ophthalmology Physician 207W00000X 2005019369 MO Primary

Addresses

Primary practice location

1225 S Grand Blvd
Saint Louis, MO 63104-1016

Mailing address

1008 S Spring Ave
Saint Louis, MO 63110-2520
Phone (314) 977-4010

Other identifiers 2

IdentifierTypeStateIssuer
1679520605MedicaidMO
200839009MedicaidMO

Electronic endpoints 2

TypeEndpointUseAffiliation
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other
Direct Messaging Address sedelstein24185@direct-ehr-ssmhc.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, IL2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20050928000003 MO Practitioner - OphthalmologyPractitioner - Internal MedicinePractitioner - OtolaryngologyPractitioner - Emergency Medicine 8820023922 Reassigns benefits to 2 organizations
I20100129000555 IL Practitioner - Ophthalmology 8820023922 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
OphthalmologyAlso: Emergency Medicine, Internal Medicine, Otolaryngology
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SSM Health Care GroupGroup PAC ID 0143608372, 929 clinicians
JFJ Eyecare LTDGroup PAC ID 8224009865, 13 clinicians

Practice addresses (Care Compare)

10101 Woodfield LN
Saint Louis, MO 63132-2946
Phone (608) 280-4647

1201 S Grand Blvd
Saint Louis, MO 63104-1016
Phone (314) 617-2000

1225 S Grand Blvd
Saint Louis, MO 63104-1016

3990 N Illinois St
Swansea, IL 62226-1919
Phone (618) 277-1130

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.94 of 100Reported as group
Quality
68.52
Promoting interoperability
100
Improvement activities
40
Cost
72.22

Merit-based Incentive Payment System (MIPS)

Final score
89.84 of 100Reported as group
Quality
92.01
Improvement activities
40
Cost
76.78

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery156

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2005019369MOMDOphthalmology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
JFJ Eyecare LTD CurrentSince Sep 1, 2009 Accepting new patients
SSM Health Care Group Emergency Medicine CurrentSince Jul 1, 2022 Accepting new patients
JFJ Eyecare, LTD CurrentSince Sep 1, 2009 Accepting new patients
SSM Health Care Group CurrentSince Jul 1, 2022 Accepting new patients
North County Emergency Physicians, LLP Emergency Medicine Past Accepting new patients

Locations

4900 W Main St
Belleville, IL 62226
Phone (618) 235-2400

103 Clintonian Plz
Breese, IL 62230
Phone (618) 526-7447

408 W 2nd St
Centralia, IL 62801
Phone (618) 532-5531

12 Professional Park Dr
Maryville, IL 62062
Phone (618) 288-7266

3990 N Illinois St
Swansea, IL 62226
Phone (618) 235-3100

10101 Woodfield Ln
Saint Louis, MO 63132
Phone (608) 280-4647

1225 S Grand Blvd
Saint Louis, MO 63104
Phone (314) 257-3390

12692 Lamplighter Square Shpg Ctr
Saint Louis, MO 63128
Phone (314) 432-5478

1402 S Grand Blvd
#G
Saint Louis, MO 63104

1755 S Grand Blvd
Saint Louis, MO 63104
Phone (314) 256-3400

3635 Vista Ave
Saint Louis, MO 63110
Phone (314) 577-8022

3691 Rutger St
Saint Louis, MO 63110
Phone (314) 268-4101

6420 Clayton Rd
Saint Louis, MO 63117
Phone (314) 768-8442

6420 Clayton Rd
#303
Saint Louis, MO 63117

8820 Manchester Rd
Saint Louis, MO 63144
Phone (314) 963-8100

Interoperability endpoints

  • Direct secure messaging: sedelstein24185@direct-ehr-ssmhc.com

Organizations & group practices 5

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 1

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": "1148688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611014400000",
    "number": "1679520605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1008 S SPRING AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631102520",
            "telephone_number": "314-977-4010",
            "fax_number": "314-977-3495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 S GRAND BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631041016",
            "telephone_number": "314-977-5200",
            "fax_number": "314-977-9910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDELSTEIN",
        "first_name": "SEAN",
        "middle_name": "LEWIS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-27",
        "last_updated": "2021-01-19",
        "certification_date": "2021-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MO",
            "license": "2005019369",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2005019369",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MO",
            "license": "2005019369",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1679520605",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200839009",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "1225 S Grand Blvd",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631041016",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sedelstein24185@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "sedelstein24185@direct-ehr-ssmhc.com",
            "address_1": "1225 S Grand Blvd",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631041016",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.