Siresha Kiran Samudrala, M.D.

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

2003001132 Issued in MO

Practice address

1 Jefferson Barracks Rd
Saint Louis, MO 63125-4181

Phone

(314) 289-6314

Fax

(314) 289-7037

NPI assigned

Apr 14, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Siresha Kiran Samudrala Professional name

Electronic endpoints 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Physician Groups LC

  • Multi-Specialty Clinic/Center
  • Saint Louis, MO
  • NPI 1285664268
  Medicare reassignment NPD
• NP Health of Mo LLC

  • Physical Medicine & Rehabilitation Physician
  • Morton Grove, IL
  • NPI 1477170959

  MO

  Medicare reassignment NPD
• Physician Groups LC

  • Multi-Specialty Clinic/Center
  • Farmington, MO
  • NPI 1427114990
  NPD
• Ozarks Medical Center

  • General Acute Care Hospital
  • West Plains, MO
  • NPI 1831115641
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1766448000000",
    "number": "1700840790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 JEFFERSON BARRACKS RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631254181",
            "telephone_number": "314-652-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 JEFFERSON BARRACKS RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631254181",
            "telephone_number": "314-289-6314",
            "fax_number": "314-289-7037"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11155 Dunn Rd Ste 109",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631366150",
            "country_code": "US",
            "telephone_number": "314-273-0149",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SAMUDRALA",
        "first_name": "SIRESHA",
        "middle_name": "KIRAN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-04-14",
        "last_updated": "2025-12-23",
        "certification_date": "2025-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MO",
            "license": "2003001132",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208749903",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "11155 Dunn Rd Ste 109",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631366150",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "SIRESHA",
            "last_name": "SAMUDRALA",
            "middle_name": "KIRAN",
            "credential": "M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Charles Michael Samson, MD
• Megan Marie Samson, MS, LSLS CERT AVED
• Pamela Parker Samson, MD
• Niki Samtani, MSW
• Ramulu Samudrala, P.C
• Suseela Samudrala, M.D.
• Samuel Lugo M.D., F.a.C.S.
• Chardial Samuel, LCSW
• Mary Catherine Samuel, MA, CCC-SLP
• Amanda Samuels, LPC

• Physical Medicine & Rehabilitation Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Physical Medicine & Rehabilitation Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2025; 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.

Verify at the official NPI Registry.