NPIMap

Individual provider Active NPI

Roohi Siraj, M.D.

  • Geriatric Medicine (Family Medicine) Physician
  • Belleville, IL
National Provider Identifier
1760885693
Registry record updated Apr 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
License
036153866 Issued in IL
Practice address
4315 Memorial Dr
Belleville, IL 62226-5342
Phone
(618) 767-7023
NPI assigned
Oct 7, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) Physician 207QG0300X 2020011597 MO
Geriatric Medicine (Family Medicine) Physician 207QG0300X 036153866 IL Primary

Addresses

Primary practice location

4315 Memorial Dr
Belleville, IL 62226-5342

Mailing address

4315 Memorial Dr
Belleville, IL 62226-5342
Phone (618) 767-7023

Other practice location 1

1 Barnes Jew Hosp Plz
Saint Louis, MO 63110-1003
Phone (314) 362-5000

Other practice location 2

3009 N Ballas Rd Ste 393C
Saint Louis, MO 63131-2322
Phone (314) 996-7014

Electronic endpoints 1

TypeEndpointUseAffiliation
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 IL, MO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20201019000250 IL Practitioner - Geriatric Medicine 2961834908 Reassigns benefits to 1 organization
I20230424001297 MO Practitioner - Geriatric Medicine 2961834908 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Geriatric Medicine
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physician Groups LCGroup PAC ID 3072421254, 526 clinicians

Practice addresses (Care Compare)

3009 N Ballas Rd
Suite 383C
Saint Louis, MO 63131-2324
Phone (314) 996-4545

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036153866ILMDGeriatric Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Physician Groups LC CurrentSince May 1, 2023 Accepting new patients
Physician Groups LC CurrentSince May 1, 2023 Accepting new patients
Fairview Heights Medical Group SC CurrentSince Oct 1, 2020 Accepting new patients
Fairview Heights Medical Group SC CurrentSince Oct 1, 2020 Accepting new patients
Delmar Gardens of O'Fallon, LLC Past Accepting new patients
Delmar Gardens West Operating, LLC Past Accepting new patients
Des Peres Healthcare, LLC Past Accepting new patients

Locations

1 Memorial Dr
Alton, IL 62002
Phone (618) 463-7240

4315 Memorial Dr
Belleville, IL 62226
Phone (618) 257-5060

2630 Highway K
O Fallon, MO 63368
Phone (636) 240-5454

3009 N Ballas Rd
Ste 383C
Saint Louis, MO 63131
Phone (314) 305-1447

3009 N Ballas Rd
Ste 393C
Saint Louis, MO 63131
Phone (314) 996-7014

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Brooking ParkChesterfield, MO, CCN 265791 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 1, 2025
May 24, 2025

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 7

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 9

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": "1412640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681862400000",
    "number": "1760885693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4315 MEMORIAL DR",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622265342",
            "telephone_number": "618-767-7023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4315 MEMORIAL DR",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622265342",
            "telephone_number": "618-767-7023"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Barnes Jew Hosp Plz",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631101003",
            "country_code": "US",
            "telephone_number": "314-362-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3009 N Ballas Rd Ste 393C",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631312322",
            "country_code": "US",
            "telephone_number": "314-996-7014",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SIRAJ",
        "first_name": "ROOHI",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-07",
        "last_updated": "2023-04-19",
        "certification_date": "2023-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "MO",
            "license": "2020011597",
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "IL",
            "license": "036153866",
            "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": "4315 Memorial Dr",
            "city": "Belleville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "622265342",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Belleville, IL

Sources for this page

Verify at the official NPI Registry.