Active NPI
Leonard F Fagan, M.D.
- Cardiovascular Disease Physician
- Saint Louis, MO
National Provider Identifier
1679570808
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cardiovascular Disease Physician
- License
- R5G47
- Practice address
- 1001 S Kirkwood Rd
Suite 100
Saint Louis, MO 63122-7254 - Phone
- (314) 965-9980
- Fax
- (314) 965-1127
- NPI assigned
- Jul 1, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | R5G47 | MO | Primary |
Addresses
Primary practice location
1001 S Kirkwood Rd
Suite 100
Saint Louis, MO 63122-7254
Mailing address
1001 S Kirkwood Rd
Suite 310
Saint Louis, MO 63122-7254
Phone (314) 965-9980
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 202362620 | Medicaid | MO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R5G47 | MO | MD | Cardiovascular Disease Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Heartland Cardiology, LLC | Cardiovascular Disease | Past | Accepting new patients |
| Ozarks Medical Center | Past | Accepting new patients | |
| Metro Heart Group of St. Louis, Inc. | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Cardiovascular Disease Physician
- Fenton, MO
- NPI 1942493317
-
- Specialist
- Festus, MO
- NPI 1487650545
-
- General Acute Care Hospital
- West Plains, MO
- NPI 1831115641
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120176000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1463702400000",
"number": "1679570808",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1001 S KIRKWOOD RD",
"address_2": "SUITE 310",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631227254",
"telephone_number": "314-965-9980",
"fax_number": "314-965-1127"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 S KIRKWOOD RD",
"address_2": "SUITE 100",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631227254",
"telephone_number": "314-965-9980",
"fax_number": "314-965-1127"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAGAN",
"first_name": "LEONARD",
"middle_name": "F",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-01",
"last_updated": "2016-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "MO",
"license": "R5G47",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "202362620",
"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 May 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.