NPIMap

Individual provider Active NPI

Kamlesh C Vyas, M.D,.

  • Internal Medicine Physician
  • Saint Louis, MO
National Provider Identifier
1679551378
Registry record updated Mar 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2005027159 Issued in MO
Practice address
3915 Watson Rd
Suite 100
Saint Louis, MO 63109-1251
Phone
(314) 881-0300
Fax
(314) 881-0321
NPI assigned
Jan 4, 2006
Last updated
Mar 16, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2021

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 2005027159 MO Primary

Addresses

Primary practice location

3915 Watson Rd
Suite 100
Saint Louis, MO 63109-1251

Mailing address

3915 Watson Rd Ste 100
Saint Louis, MO 63109-1251
Phone (314) 881-0300

Other identifiers 2

IdentifierTypeStateIssuer
207481011MedicaidMO
207481003MedicaidMO

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address SouthStLouisMedicalAssociates.KamleshVyas@119671.advancedmd-direct.com Direct

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
I20051027000301 MO Practitioner - Internal Medicine 3173540366 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Madhuram LLCGroup PAC ID 3072911825, 2 clinicians
South St Louis Medical Associates LLCGroup PAC ID 1153510888, 2 clinicians
Aging Well Health Care, LLCGroup PAC ID 1153232038, 236 clinicians

Practice addresses (Care Compare)

15197 Clayton Rd
Chesterfield, MO 63017-7048
Phone (636) 394-7515

3824 Watson Rd
Saint Louis, MO 63109-1237
Phone (314) 881-0300

3915 Watson Rd
Saint Louis, MO 63109-1251
Phone (314) 881-0333

7212 Balson Ave
Saint Louis, MO 63130-3001

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2005027159MOMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Madhuram LLC Internal Medicine CurrentSince Jun 10, 2021 Accepting new patients
South St Louis Medical Associates LLC Internal Medicine CurrentSince Apr 1, 2011 Accepting new patients
County of St Louis Division of Fiscal Management Past Accepting new patients

Locations

15197 Clayton Rd
Chesterfield, MO 63017
Phone (636) 394-7515

3824 Watson Rd
Saint Louis, MO 63109
Phone (314) 352-4400

3915 Watson Rd
Ste 100
Saint Louis, MO 63109
Phone (314) 646-0478

Organizations & group practices 4

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 10

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": "1136332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615852800000",
    "number": "1679551378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3915 WATSON RD STE 100",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631091251",
            "telephone_number": "314-881-0300",
            "fax_number": "636-225-5552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3915 WATSON RD",
            "address_2": "SUITE 100",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631091251",
            "telephone_number": "314-881-0300",
            "fax_number": "314-881-0321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VYAS",
        "first_name": "KAMLESH",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "M.D,.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-04",
        "last_updated": "2021-03-16",
        "certification_date": "2021-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2005027159",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "207481011",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "207481003",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "SouthStLouisMedicalAssociates.KamleshVyas@119671.advancedmd-direct.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3915 Watson Rd",
            "address_2": "Suite 100",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631091251",
            "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.