NPIMap

Individual provider Active NPI

Christian C Nwankwo, MD

  • Nephrology Physician
  • Saint Louis, MO
National Provider Identifier
1679772198
Registry record updated Oct 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
2010019786 Issued in MO
Practice address
10004 Kennerly Rd
Suite 374B
Saint Louis, MO 63128-2141
Phone
(314) 842-9669
Fax
(314) 842-1017
NPI assigned
Jul 13, 2007
Last updated
Oct 2, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 2007007870 MO
Nephrology Physician 207RN0300X 2010019786 MO Primary

Addresses

Primary practice location

10004 Kennerly Rd
Suite 374B
Saint Louis, MO 63128-2141

Mailing address

PO Box 802841
Kansas City, MO 64180-2841
Phone (314) 842-9669

Other identifiers 1

IdentifierTypeStateIssuer
1679772198MedicaidMO

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
I20100817001219 MO Practitioner - Internal MedicinePractitioner - Emergency Medicine 8820122542 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Emergency Medicine
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
NHS South LLCGroup PAC ID 1658797246, 9 clinicians

Practice addresses (Care Compare)

6420 Clayton Rd
Richmond Heights, MO 63117-1811
Phone (314) 768-8000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2007007870MOMDInternal Medicine Physician
2010019786MOMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
SSM Health Care St Louis CurrentSince Jan 1, 2016 Accepting new patients
NHS South LLC Nephrology CurrentSince Oct 1, 2020 Accepting new patients
Inpatient Consultants of Missouri Inc Internal Medicine Past Accepting new patients

Locations

7344 Solutions Ctr
Chicago, IL 60677
Phone (314) 989-6189

1011 Bowles Ave
Ste 220
Fenton, MO 63026
Phone (636) 681-3030

1015 Bowles Ave
Fenton, MO 63026
Phone (636) 496-2000

300 1st Capitol Dr
Saint Charles, MO 63301
Phone (636) 669-2211

10004 Kennerly Rd
Saint Louis, MO 63128
Phone (314) 525-4100

10004 Kennerly Rd
Ste 374B
Saint Louis, MO 63128
Phone (314) 294-9210

10241 Lewis and Clark Blvd
Saint Louis, MO 63136
Phone (314) 868-5982

10435 Clayton Rd
Ste 201
Saint Louis, MO 63131
Phone (314) 567-0645

11133 Dunn Rd
Saint Louis, MO 63136
Phone (314) 653-5000

6400 Clayton Rd
Ste 405
Saint Louis, MO 63117
Phone (314) 729-0077

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

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

8980 Natural Bridge Rd
Saint Louis, MO 63121
Phone (314) 426-2064

Interoperability endpoints

  • Direct secure messaging: cnwankwo5464@direct-ehr-ssmhc.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 12

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": "1184284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696204800000",
    "number": "1679772198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 802841",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641802841",
            "telephone_number": "314-842-9669",
            "fax_number": "314-842-1017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10004 KENNERLY RD",
            "address_2": "SUITE 374B",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631282141",
            "telephone_number": "314-842-9669",
            "fax_number": "314-842-1017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NWANKWO",
        "first_name": "CHRISTIAN",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-13",
        "last_updated": "2023-10-02",
        "certification_date": "2023-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2007007870",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "MO",
            "license": "2010019786",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1679772198",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.