Active NPI
Subbarao Polineni, MD
- Surgery of the Hand (Surgery) Physician
- St Peters, MO
National Provider Identifier
1699766980
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery of the Hand (Surgery) Physician
- License
- R7957
- Practice address
- 6 Jungerman Cir
Ste 107
St Peters, MO 63376 - Phone
- (636) 928-1696
- Fax
- (636) 928-3115
- NPI assigned
- Nov 4, 2005
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Surgery of the Hand (Surgery) Physician | 2086S0105X | R7957 | MO | Primary |
Addresses
Primary practice location
6 Jungerman Cir
Ste 107
St Peters, MO 63376
Mailing address
6 Jungerman Cir
Ste 107
St Peters, MO 63376
Phone (636) 928-1696
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 201653805 | Medicaid | MO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Barnes Jewish St. Peters Hospital Inc. | Past | Accepting new patients |
Interoperability endpoints
- spolineni135281@direct.carenet.org
- https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
Organizations & group practices 1
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.
-
- General Practice Physician
- Saint Peters, MO
- NPI 1235148271
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131062400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1195603200000",
"number": "1699766980",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6 JUNGERMAN CIR",
"address_2": "STE 107",
"city": "ST PETERS",
"state": "MO",
"postal_code": "63376",
"telephone_number": "636-928-1696",
"fax_number": "636-928-3115"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6 JUNGERMAN CIR",
"address_2": "STE 107",
"city": "ST PETERS",
"state": "MO",
"postal_code": "63376",
"telephone_number": "636-928-1696",
"fax_number": "636-928-3115"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLINENI",
"first_name": "SUBBARAO",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-11-04",
"last_updated": "2007-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "2086S0105X",
"taxonomy_group": "",
"desc": "Surgery, Surgery of the Hand",
"state": "MO",
"license": "R7957",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "201653805",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in St Peters, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.