NPIMap

Individual provider Active NPI

Kelly D Gage, M.D.

  • Internal Medicine Physician
  • Saint Louis, MO
National Provider Identifier
1710930219
Registry record updated Apr 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
R6J64 Issued in MO
Practice address
3844 S Lindbergh Blvd.
Suite 160
St. Louis, MO 63127
Phone
(314) 698-2500
Fax
(314) 698-2323
NPI assigned
May 18, 2006
Last updated
Apr 18, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2014

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 R6J64 MO Primary

Addresses

Primary practice location

3844 S Lindbergh Blvd.
Suite 160
St. Louis, MO 63127

Mailing address

3844 S Lindbergh Blvd.
Suite 160
St. Louis, MO 63127
Phone (314) 698-2500

Other identifiers 1

IdentifierTypeStateIssuer
P01134613OtherMORAILROAD MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100915000516 MO Practitioner - Internal Medicine 7113017187 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Saint Louis University School of Medicine, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mercy Clinic East CommunitiesGroup PAC ID 7214827922, 573 clinicians

Practice addresses (Care Compare)

12200 Weber Hill Rd
Suite 100
Saint Louis, MO 63127-1569
Phone (636) 390-1684

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R6J64MOMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic East Communities Internal Medicine CurrentSince Jul 1, 2012 Accepting new patients
SSM Medical Group Inc. Past Accepting new patients
SSM Depaul Medical Group, Inc. Internal Medicine Past Accepting new patients

Locations

1015 Bowles Ave
Ste 1000
Fenton, MO 63026
Phone (636) 390-1400

9513 Highway 100
New Haven, MO 63068
Phone (573) 237-6100

10010 Kennerly Rd
Saint Louis, MO 63128
Phone (314) 525-1328

12200 Weber Hill Rd
Ste 100
Saint Louis, MO 63127
Phone (314) 698-2400

3844 S Lindbergh Blvd
Ste 160
Saint Louis, MO 63127
Phone (314) 698-2400

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

901 Patients First Dr
Washington, MO 63090
Phone (636) 239-7500

Interoperability endpoints

  • Direct secure messaging: kgage303152@directc.mercy.net

Organizations & group practices 3

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 12

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": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1397779200000",
    "number": "1710930219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3844 S LINDBERGH BLVD.",
            "address_2": "SUITE 160",
            "city": "ST. LOUIS",
            "state": "MO",
            "postal_code": "63127",
            "telephone_number": "314-698-2500",
            "fax_number": "314-698-2323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3844 S LINDBERGH BLVD.",
            "address_2": "SUITE 160",
            "city": "ST. LOUIS",
            "state": "MO",
            "postal_code": "63127",
            "telephone_number": "314-698-2500",
            "fax_number": "314-698-2323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAGE",
        "first_name": "KELLY",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-18",
        "last_updated": "2014-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "R6J64",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01134613",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.