Individual provider Active NPI

Donald Richardson, M.D.

  • Internal Medicine Physician
  • Saint Louis, MO
National Provider Identifier
1700867215
Registry record updated Sep 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
R6979 Issued in MO
Practice address
12345 W Bend Dr
Suite 300
Saint Louis, MO 63128-2182
Phone
(314) 849-6000
Fax
(314) 849-1417
NPI assigned
Nov 10, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) Physician 207QG0300X R6979 MO
Internal Medicine Physician 207R00000X R6979 MO Primary

Addresses

Primary practice location

12345 W Bend Dr
Suite 300
Saint Louis, MO 63128-2182

Mailing address

PO Box 23340
Saint Louis, MO 63156-3340
Phone (314) 849-6000

Other identifiers 8

IdentifierTypeStateIssuer
4214916OtherMOAETNA
000000010031OtherMOESSENCE
9184OtherMOBCBS
201659414MedicaidMO
A10039OtherMOMERCY
127486OtherMOGHP
0400272OtherMOUHC
114793OtherMOHEALTHLINK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
American Multispecialty Group Inc. Internal Medicine CurrentSince Oct 1, 1995 Accepting new patients

Locations

5034 Griffin Rd
Saint Louis, MO 63128
Phone (314) 645-3743

12345 W Bend Dr
Ste 300
Saint Louis, MO 63128
Phone (314) 849-6000

9930 Watson Rd
Saint Louis, MO 63126
Phone (314) 984-8827

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.

NPI Registry JSON

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

{
    "created_epoch": "1131580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348790400000",
    "number": "1700867215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23340",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631563340",
            "telephone_number": "314-849-6000",
            "fax_number": "314-849-1417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12345 W BEND DR",
            "address_2": "SUITE 300",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631282182",
            "telephone_number": "314-849-6000",
            "fax_number": "314-849-1417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICHARDSON",
        "first_name": "DONALD",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-10",
        "last_updated": "2012-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "MO",
            "license": "R6979",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "R6979",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4214916",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ESSENCE",
            "identifier": "000000010031",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "9184",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201659414",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MERCY",
            "identifier": "A10039",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHP",
            "identifier": "127486",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC",
            "identifier": "0400272",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "114793",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.