Active NPI
Fenton Family Physicians, LLC
- Family Medicine Physician
- Fenton, MO
National Provider Identifier
1679939128
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- FENTON FAMILY PHYSICIANS, LLC
- Practice address
- 774 Gravois Bluffs Blvd Ste B
Fenton, MO 63026-7758 - Phone
- (636) 685-7734
- Fax
- (314) 590-5922
- NPI assigned
- Jan 13, 2016
- Organization subpart
- Yes
- Parent organization
- ST. LUKES MEDICAL GROUP
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Darren R. Haskell, M.D.
- Title
- Chief Medical Officer
- Phone
- (314) 205-6444
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
774 Gravois Bluffs Blvd Ste B
Fenton, MO 63026-7758
Mailing address
774 Gravois Bluffs Blvd
Fenton, MO 63026-7758
Phone (636) 685-7804
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160506001655 | MO | Part B Supplier - Clinic/Group Practice | 5799084091 |
Receives reassigned benefits from 10 practitioners Practice locations: Fenton, MO |
National Provider Directory
National Provider Directory- Part of
- St Lukes Medical Group
Locations
774 Gravois Bluffs Blvd
Fenton, MO 63026
Phone (636) 343-5223
Parent organization (reported in NPPES) 1
This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.
-
- Family Medicine Physician
- Chesterfield, MO
- NPI 1215308945
Practitioners 11
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Internal Medicine Physician
- Saint Louis, MO
- NPI 1093235970
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1452643200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1772668800000",
"number": "1679939128",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "774 GRAVOIS BLUFFS BLVD",
"city": "FENTON",
"state": "MO",
"postal_code": "630267758",
"telephone_number": "636-685-7804",
"fax_number": "314-336-5205"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "774 GRAVOIS BLUFFS BLVD STE B",
"city": "FENTON",
"state": "MO",
"postal_code": "630267758",
"telephone_number": "636-685-7734",
"fax_number": "314-590-5922"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FENTON FAMILY PHYSICIANS, LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "ST. LUKES MEDICAL GROUP",
"enumeration_date": "2016-01-13",
"last_updated": "2026-03-05",
"certification_date": "2026-03-05",
"status": "A",
"authorized_official_last_name": "HASKELL",
"authorized_official_first_name": "DARREN",
"authorized_official_middle_name": "R.",
"authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
"authorized_official_telephone_number": "314-205-6444",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fenton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2026; 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.