NPIMap

Individual provider Active NPI

Ali Etemady-Deylamy

  • Infectious Disease Physician
  • Saint Louis, MO
National Provider Identifier
1760864888
Registry record updated Aug 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
License
2017016664 Issued in MO
Practice address
10010 Kennerly Rd
Saint Louis, MO 63128
Phone
(314) 525-1328
NPI assigned
Jun 25, 2015
Last updated
Aug 17, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 5101021789 MI
Internal Medicine Physician 207R00000X 2016015544 MO
Internal Medicine Physician 207R00000X 2017016664 MO
Infectious Disease Physician 207RI0200X 2017016664 MO Primary

Addresses

Primary practice location

10010 Kennerly Rd
Saint Louis, MO 63128

Mailing address

10010 Kennerly Rd
Saint Louis, MO 63128-2106
Phone (314) 525-1328

Other practice location 1

1900 Columbus Ave
Bay City, MI 48708-6831
Phone (989) 894-3950

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
I20190326001069 MO Practitioner - Internal Medicine 4486946076 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Infectious Diseases PCGroup PAC ID 6305880956, 10 clinicians

Practice addresses (Care Compare)

10010 Kennerly Rd
Saint Louis, MO 63128-2106
Phone (314) 525-1328

330 1St Capitol Dr
Suite 260
St Charles, MO 63128
Phone (636) 925-0900

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101021789MIMDFamily Medicine Physician
2016015544MOMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Adult Hospitalists- Jefferson, LLC Internal Medicine CurrentSince Dec 8, 2019 Accepting new patients
Infectious Disease Infectious Disease CurrentSince Jul 1, 2022 Accepting new patients
St Anthonys Physician Organization Hospitalist Services, L.C. CurrentSince Feb 19, 2019 Accepting new patients
Infectious Diseases PC Infectious Disease CurrentSince Aug 1, 2023 Accepting new patients
Mercy Clinic Adult Hospitalists - St. Louis, LLC Internal Medicine CurrentSince Dec 8, 2019 Accepting new patients
Mercy Clinic Adult Hospitalists - Washington, LLC CurrentSince Dec 8, 2019 Accepting new patients
Infectious Diseases, PC Infectious Disease CurrentSince Aug 1, 2023 Accepting new patients
Mercy Hospital Lincoln Family Medicine CurrentSince Dec 8, 2019 Accepting new patients

Locations

1400 US Highway 61
Crystal Cty, MO 63028
Phone (636) 933-1111

330 1st Capitol Dr
Ste 260
Saint Charles, MO 63301
Phone (636) 723-6800

400 1st Capitol Dr
Ste 300
Saint Charles, MO 63301
Phone (636) 925-0900

10004 Kennerly Rd
Ste 295B
Saint Louis, MO 63128
Phone (314) 500-2424

10010 Kennerly Rd
Saint Louis, MO 63128
Phone (314) 525-1328

615 S New Ballas Rd
#H
Saint Louis, MO 63141
Phone (314) 251-6075

900 E Cherry St
Troy, MO 63379
Phone (636) 528-8585

901 E 5th St
Washington, MO 63090
Phone (636) 239-8000

Interoperability endpoints

  • Direct secure messaging: aetemadydeylamy205048@direct-ehr-ssmhc.com

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1435190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692230400000",
    "number": "1760864888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10010 KENNERLY RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631282106",
            "telephone_number": "314-525-1328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10010 KENNERLY RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "63128",
            "telephone_number": "314-525-1328"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1900 Columbus Ave",
            "address_purpose": "LOCATION",
            "city": "Bay City",
            "state": "MI",
            "postal_code": "487086831",
            "country_code": "US",
            "telephone_number": "989-894-3950",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ETEMADY-DEYLAMY",
        "first_name": "ALI",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-25",
        "last_updated": "2023-08-17",
        "certification_date": "2023-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101021789",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2016015544",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2017016664",
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "MO",
            "license": "2017016664",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.