Active NPI
Natsumon Udomkittivorakul, MD
- Pediatrics Physician
- Saint Louis, MO
National Provider Identifier
1730756420
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 2024026020
- Practice address
- Wusm Peds, 1 Childrens PL MSC 8116-0043-14
Saint Louis, MO 63110-1002 - Phone
- (314) 454-2094
- Fax
- (314) 454-2515
- NPI assigned
- Jun 10, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 2024026020 | MO | Primary |
Addresses
Primary practice location
Wusm Peds, 1 Childrens PL MSC 8116-0043-14
Saint Louis, MO 63110-1002
Mailing address
Wusm Peds, 1 Childrens PL MSC 8116-0043-14
Saint Louis, MO 63110-1002
Phone (314) 454-2094
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| FHIR URL | https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210825002385 | MO | Order and Referring Only - Pediatric Medicine | 5092110312 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1623283200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1720051200000",
"number": "1730756420",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "WUSM PEDS, 1 CHILDRENS PL MSC 8116-0043-14",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631101002",
"telephone_number": "314-454-2094",
"fax_number": "314-454-2515"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "WUSM PEDS, 1 CHILDRENS PL MSC 8116-0043-14",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631101002",
"telephone_number": "314-454-2094",
"fax_number": "314-454-2515"
}
],
"practiceLocations": [],
"basic": {
"last_name": "UDOMKITTIVORAKUL",
"first_name": "NATSUMON",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-06-10",
"last_updated": "2024-07-04",
"certification_date": "2024-07-04",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MO",
"license": "2024026020",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
"affiliation": "N",
"endpointDescription": "BJC",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "1 Childrens Pl Ste 3S34",
"city": "Saint Louis",
"state": "MO",
"country_code": "US",
"postal_code": "631101002",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 4, 2024; 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.