Individual provider Active NPI

Kevin Tianber Yin

  • Internal Medicine Physician
  • O'Fallon, MO
National Provider Identifier
1689311011
Registry record updated Aug 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2025011705 Issued in MO
Practice address
2223 Technology Dr Ste 35
O Fallon, MO 63368-7272
Phone
(636) 561-5999
NPI assigned
May 17, 2022
Last updated
Aug 6, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 6, 2025

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 2025011705 MO Primary

Addresses

Primary practice location

2223 Technology Dr Ste 35
O Fallon, MO 63368-7272

Mailing address

PO Box 776084
Chicago, IL 60677-6084
Phone (369) 787-9026

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251006000234 MO Practitioner - Internal Medicine 8224418017 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Saint Louis University School of Medicine, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinic East CommunitiesGroup PAC ID 7214827922, shared by 6 NPIs, 573 clinicians

Practice addresses (Care Compare)

2223 Technology Dr
Suite 40
O Fallon, MO 63368-7272
Phone (636) 755-4400

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic East Communities Single Specialty Current Accepting new patients
Mercy Clinic East Communities Single Specialty CurrentSince Sep 15, 2025 Accepting new patients

Locations

2223 Technology Dr
Ste 35
O Fallon, MO 63368
Phone (636) 561-5999

2223 Technology Dr
Ste 40
O Fallon, MO 63368
Phone (636) 755-4400

621 S New Ballas Rd
Ste 189A
Saint Louis, MO 63141
Phone (314) 251-6335

621 S New Ballas Rd
Ste 4017B
Saint Louis, MO 63141
Phone (314) 872-9192

851 E 5th St
Ste 328
Washington, MO 63090
Phone (636) 239-1101

Organizations & group practices 2

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 2

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": "1652745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754438400000",
    "number": "1689311011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776084",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606776084",
            "telephone_number": "369-787-9026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2223 TECHNOLOGY DR STE 35",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633687272",
            "telephone_number": "636-561-5999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YIN",
        "first_name": "KEVIN",
        "middle_name": "TIANBER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-05-17",
        "last_updated": "2025-08-06",
        "certification_date": "2025-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2025011705",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in O'Fallon, MO

Sources for this page

Verify at the official NPI Registry.