St Louis Kidney, LLC

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

Legal business name

ST LOUIS KIDNEY, LLC

Practice address

456 N New Ballas Rd Ste 348
Creve Coeur, MO 63141-6846

Phone

(314) 548-0265

Fax

(314) 548-6555

NPI assigned

Jun 18, 2014

Last updated

Sep 30, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Derek Sloan Larson, MDNPI 1588820096

Title

Owner

Phone

(314) 548-0265

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Derek Sloan Larson, M.D.

  • Nephrology Physician
  • Creve Coeur, MO
  • NPI 1588820096
  Medicare reassignment Care Compare group Authorized official
• Rohan Devanpalli-Ramaya, M.D

  • Internal Medicine Physician
  • Creve Coeur, MO
  • NPI 1396057535
  Medicare reassignment Care Compare group NPD
• Graeme Mindel, M.D.

  • Nephrology Physician
  • Creve Coeur, MO
  • NPI 1932196854
  Medicare reassignment Care Compare group NPD
• Nathaniel Cantey Reisinger, MD

  • Nephrology Physician
  • Creve Coeur, MO
  • NPI 1881960938
  Medicare reassignment Care Compare group NPD
• Candace Shirley, NP-C

  • Family Nurse Practitioner
  • Creve Coeur, MO
  • NPI 1891242921
  Medicare reassignment Care Compare group NPD
• Brittany Ann Heady, PA

  • Physician Assistant
  • Saint Louis, MO
  • NPI 1922345214
  Medicare reassignment Care Compare group
• Justin Krafft, PA-C

  • Physician Assistant
  • Saint Louis, MO
  • NPI 1245828904
  Medicare reassignment Care Compare group
• Kenneth Richard Rohrbach Jr., PA-C

  • Medical Physician Assistant
  • Saint Louis, MO
  • NPI 1912247123
  Medicare reassignment Care Compare group
• Jay R Seltzer, MD

  • Nephrology Physician
  • Creve Coeur, MO
  • NPI 1568433902
  Medicare reassignment Care Compare group
• Rose Mattli, NP

  • Nurse Practitioner
  • Creve Coeur, MO
  • NPI 1760704290
  NPD

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

{
    "created_epoch": "1403049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759190400000",
    "number": "1730593757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 78429",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631788429",
            "telephone_number": "314-548-0265",
            "fax_number": "314-548-6555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "456 N NEW BALLAS RD STE 348",
            "city": "CREVE COEUR",
            "state": "MO",
            "postal_code": "631416846",
            "telephone_number": "314-548-0265",
            "fax_number": "314-548-6555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST LOUIS KIDNEY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-18",
        "last_updated": "2025-09-30",
        "certification_date": "2025-09-30",
        "status": "A",
        "authorized_official_last_name": "LARSON",
        "authorized_official_first_name": "DEREK",
        "authorized_official_middle_name": "SLOAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "314-548-0265",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500014637",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Luann Spencer-Steele, LPC
• Mary Lauren Spencer, NP
• SSM Health Surgery Center, LLC
• St Louis County Internal Medicine Inc
• St Louis Joint and Back Pain Specialists LLC
• St Louis Pet Centers, LLC
• St Lukes Immediate Care LLC
• St. Louis Center for Cognitive Health, LLC
• St. Louis Laser LLC
• St. Louis Spine & Health Associates

• Nephrology Physician in Creve Coeur, MO
• Providers in Creve Coeur, MO by specialty
• Nephrology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.