NPIMap

Individual provider Active NPI

Emmanuel A Venkatesan, MD

  • Internal Medicine Physician
  • Saint Louis, MO
National Provider Identifier
1730185745
Registry record updated Apr 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
105561 Issued in MO
Practice address
4320 Forest Park Ave
Ste 1100
Saint Louis, MO 63108-2979
Phone
(314) 333-4100
Fax
(314) 333-4115
NPI assigned
Jun 23, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2025

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 105561 MO Primary

Addresses

Primary practice location

4320 Forest Park Ave
Ste 1100
Saint Louis, MO 63108-2979

Mailing address

PO Box 7412037
Chicago, IL 60674-2037
Phone (314) 333-4100

Other identifiers 1

IdentifierTypeStateIssuer
208892851MedicaidMO

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Washington University

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
I20050916000141 MO Practitioner - Internal Medicine 1153354402 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

4320 Forest Park Ave
Suite 1100
Saint Louis, MO 63108-2979
Phone (314) 333-4100

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.2 of 100Reported as group
Quality
71.6
Promoting interoperability
100
Improvement activities
40
Cost
75.75

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Washington University CurrentSince Jan 1, 2014 Accepting new patients
Affinia Healthcare Past Accepting new patients

Locations

114 N Taylor Ave
Saint Louis, MO 63108
Phone (314) 534-8600

Interoperability endpoints

  • Direct secure messaging: evenkatesan161622@direct.carenet.org

Organizations & group practices 4

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 5

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": "1119484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744848000000",
    "number": "1730185745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7412037",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606742037",
            "telephone_number": "314-333-4100",
            "fax_number": "314-333-4115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4320 FOREST PARK AVE",
            "address_2": "STE 1100",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631082979",
            "telephone_number": "314-333-4100",
            "fax_number": "314-333-4115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VENKATESAN",
        "first_name": "EMMANUEL",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-23",
        "last_updated": "2025-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "105561",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208892851",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "4320 Forest Park Ave",
            "address_2": "Ste 1100",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631082979",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.