Kristina Radoulova, M.D.

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

2009005467 Issued in MO

Practice address

621 S New Ballas Rd Ste 693a
Saint Louis, MO 63141-8263

Phone

(314) 251-6898

NPI assigned

Jul 16, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 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

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kradoulova101386@directc.mercy.net

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.

• Mercy Clinic Child and Adolescent Psychiatry, LLC

  • Child & Adolescent Psychiatry Physician
  • Saint Louis, MO
  • NPI 1265562300
  Medicare reassignment NPD

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

{
    "created_epoch": "1184544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1720287089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 S NEW BALLAS RD STE 693A",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418263",
            "telephone_number": "314-251-6898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 S NEW BALLAS RD STE 693A",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418263",
            "telephone_number": "314-251-6898"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12348 Old Tesson Rd Ste 160",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631282251",
            "country_code": "US",
            "telephone_number": "314-251-6898",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "851 E 5th St",
            "address_2": "Ste. 200",
            "address_purpose": "LOCATION",
            "city": "Washington",
            "state": "MO",
            "postal_code": "630903135",
            "country_code": "US",
            "telephone_number": "636-239-8585",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RADOULOVA",
        "first_name": "KRISTINA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-16",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "MO",
            "license": "2009005467",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1720287089",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Radiology and Imaging Management Services, LLC
• Connie Sue Radke, APRN-NP
• John D Radke, MD
• Shelah Radke, M.D., J.D.
• Patrick John Radler, FNP-C
• Zachary Picker Radwine, M.D.
• Benjamin Weston Rael, MD
• Rafat Nashed Orthopedics, Inc
• Shokooh K Rafati, MA LPC
• Jennifer Christine Raffaelli, ANP

• Child & Adolescent Psychiatry Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Child & Adolescent Psychiatry Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.