Individual provider Active NPI

Nand K Kodwani, MD

  • Anesthesiology Physician
  • Bridgeton, MO
National Provider Identifier
1720078884
Registry record updated Feb 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
MD114524 Issued in MO
Practice address
12303 Depaul Dr
Bridgeton, MO 63044
Phone
(314) 344-7049
Fax
(314) 344-7073
NPI assigned
Oct 28, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 036.146368 IL
Anesthesiology Physician 207L00000X MD114524 MO Primary

Addresses

Primary practice location

12303 Depaul Dr
Bridgeton, MO 63044

Mailing address

12303 Depaul Dr
Bridgeton, MO 63044
Phone (314) 344-7049

Other identifiers 1

IdentifierTypeStateIssuer
203876719MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, IL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20100720000226 MO Practitioner - Anesthesiology 9638274988 Reassigns benefits to 2 organizations
I20180712001430 IL Practitioner - Anesthesiology 9638274988 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North American Partners in Anesthesia Illinois LLCGroup PAC ID 1052576519, 431 clinicians

Practice addresses (Care Compare)

1 Saint Elizabeth Blvd
O Fallon, IL 62269-1099
Phone (618) 234-2120

Hospital & facility affiliations

  • HSHS St Elizabeth'S Hospital Hospital, O Fallon, IL, CCN 140187

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.146368ILMDAnesthesiology Physician
MD114524MOMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
SSM Health Slu Hospital Anesthesia Physician Billing, LLC Anesthesiology CurrentSince Feb 9, 2019 Accepting new patients
Aim Anesthesia LLC Anesthesiology CurrentSince Feb 10, 2020 Accepting new patients
North American Partners in Anesthesia (Illinois), LLC Anesthesiology CurrentSince Jun 2, 2022 Accepting new patients
Eye Anesthesia LLC Anesthesiology PastSince Jul 1, 2012 Accepting new patients
Northwest Anesthesia LTD Anesthesiology Past Accepting new patients

Locations

3249 Oak Park Ave
Berwyn, IL 60402
Phone (708) 783-2696

1215 Franciscan Dr
Litchfield, IL 62056
Phone (217) 324-2191

1 Saint Elizabeth Blvd
O Fallon, IL 62269
Phone 618234212012438

9515 Holy Cross Ln
Saint Rose, IL 62230
Phone (618) 526-4511

3550 McKelvey Rd
Bridgeton, MO 63044
Phone 31474109114048

1101 W Gannon Dr
Festus, MO 63028
Phone (636) 931-5997

1201 S Grand Blvd
Saint Louis, MO 63104
Phone (314) 257-8222

3635 Vista Ave
Saint Louis, MO 63110
Phone (314) 577-8022

1305 Walt Whitman Rd
Ste 300
Melville, NY 11747
Phone (516) 370-3796

Organizations & group practices 5

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.

Hospital & facility affiliations 1

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": "1130457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677024000000",
    "number": "1720078884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12303 DEPAUL DR",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "63044",
            "telephone_number": "314-344-7049",
            "fax_number": "314-344-7073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12303 DEPAUL DR",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "63044",
            "telephone_number": "314-344-7049",
            "fax_number": "314-344-7073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KODWANI",
        "first_name": "NAND",
        "middle_name": "K",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-28",
        "last_updated": "2023-02-22",
        "certification_date": "2023-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IL",
            "license": "036.146368",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MO",
            "license": "MD114524",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "203876719",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeton, MO

Sources for this page

Verify at the official NPI Registry.