NPIMap

Organization Active NPI

Vadim Baram MD, Inc.

  • Geriatric Psychiatry Physician
  • Saint Louis, MO
National Provider Identifier
1770743189
Registry record updated Sep 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Psychiatry PhysicianTaxonomy code 2084P0805X
License
2004022302 Issued in MO
Legal business name
VADIM BARAM MD, INC.
Practice address
10420 Old Olive Street Rd Ste 205
Saint Louis, MO 63141-5937
Phone
(314) 692-8516
Fax
(314) 692-9978
NPI assigned
Jun 10, 2008
Last updated
Sep 25, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2020

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

Authorized official

Name
Caren Zinn
Title
Office Manager
Phone
(314) 692-8516

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Psychiatry Physician 2084P0805X 2004022302 MO Primary

Addresses

Primary practice location

10420 Old Olive Street Rd Ste 205
Saint Louis, MO 63141-5937

Mailing address

10420 Old Olive Street Rd Ste 205
Saint Louis, MO 63141-5937
Phone (314) 692-8516

Other identifiers 1

IdentifierTypeStateIssuer
209106806MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, IL, FL, NY4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20080617000763 MO Part B Supplier - Clinic/Group Practice 4486725595 Receives reassigned benefits from 15 practitioners
Practice locations: St Louis, MO; Saint Louis, MO; Bridgeton, MO; Maryland Heights, MO; Florissant, MO; Chesterfield, MO
O20200622000681 IL Part B Supplier - Clinic/Group Practice 4486725595 Receives reassigned benefits from 4 practitioners
Practice locations: Bethalto, IL; Columbia, IL; Shiloh, IL
O20200715000340 FL Part B Supplier - Clinic/Group Practice 4486725595 Receives reassigned benefits from 2 practitioners
Practice locations: Sunny Isles Beach, FL
O20200731000957 NY Part B Supplier - Clinic/Group Practice 4486725595 Practice locations: New York, NY

National Provider Directory

National Provider Directory

Locations

615 Rancho Ln
Florissant, MO 63031
Phone (314) 837-4438

1127 Timber Run Dr
Saint Louis, MO 63146
Phone (314) 317-2003

971 Lexington Ave
Apt 1A
New York, NY 10021
Phone (314) 692-8516

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1213056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600992000000",
    "number": "1770743189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10420 OLD OLIVE STREET RD STE 205",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631415937",
            "telephone_number": "314-692-8516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10420 OLD OLIVE STREET RD STE 205",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631415937",
            "telephone_number": "314-692-8516",
            "fax_number": "314-692-9978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VADIM BARAM MD, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-10",
        "last_updated": "2020-09-25",
        "certification_date": "2020-09-25",
        "status": "A",
        "authorized_official_last_name": "ZINN",
        "authorized_official_first_name": "CAREN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "314-692-8516"
    },
    "taxonomies": [
        {
            "code": "2084P0805X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "MO",
            "license": "2004022302",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "209106806",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "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 Sep 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.