NPIMap

Organization Active NPI

Fenton Family Physicians, LLC

  • Family Medicine Physician
  • Fenton, MO
National Provider Identifier
1679939128
Registry record updated Mar 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
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
Last updated
Mar 5, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
ST. LUKES MEDICAL GROUPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 5, 2026

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

Authorized official

Name
Darren R. Haskell, M.D.NPI 1689636813
Title
Chief Medical Officer
Phone
(314) 205-6444

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 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 IDStateProvider typePAC IDDetails
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

Ownership & related parties

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.

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

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.

Verify at the official NPI Registry.