Active NPI
St Louis Kidney Care LLC
- Nephrology Physician
- Florissant, MO
National Provider Identifier
1780058727
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- Legal business name
- ST LOUIS KIDNEY CARE LLC
- Practice address
- 1265 Graham Rd Ste 1
Florissant, MO 63031-8018 - Phone
- (314) 741-1600
- Fax
- (314) 741-1677
- NPI assigned
- Nov 13, 2015
- Last updated
- Jul 24, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ryan Valle
- Title
- President
- Phone
- (781) 699-9362
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | Primary |
Addresses
Primary practice location
1265 Graham Rd Ste 1
Florissant, MO 63031-8018
Mailing address
1265 Graham Rd Ste 1
Florissant, MO 63031-8018
Phone (314) 741-1600
Other practice location 1
55 Nesbit Dr Ste B
Bonne Terre, MO 63628-1353
Phone (636) 937-3337
Other practice location 2
2044 Madison Ave Ste 15
Granite City, IL 62040-4641
Phone (314) 741-1600
Other practice location 3
1400 US Highway 61 Ste 240A
Festus, MO 63028-4141
Phone (636) 937-3337
Other practice location 4
2 Memorial Dr Ste 201
Alton, IL 62002-6723
Phone (314) 741-1600
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 455247262-04915-01 | Medicaid | IL | |
| 500035811 | Medicaid | MO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO, IL
Enrollment records 2
National Provider Directory
National Provider DirectoryLocations
1400 US Highway 61
Ste 240A
Crystal Cty, MO 63028
Phone (636) 937-3337
1265 Graham Rd
Ste 1
Florissant, MO 63031
Phone (314) 551-0338
11155 Dunn Rd
Ste 211N
Saint Louis, MO 63136
Phone (314) 355-0018
Practitioners & affiliated clinicians
Practitioners 8
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.
-
- Nurse Practitioner
- Festus, MO
- NPI 1114404811
-
- Nephrology Physician
- Florissant, MO
- NPI 1356827182
-
- Nephrology Physician
- Festus, MO
- NPI 1811188758
-
- Nephrology Physician
- Festus, MO
- NPI 1316186836
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1447372800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1721779200000",
"number": "1780058727",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1265 GRAHAM RD STE 1",
"city": "FLORISSANT",
"state": "MO",
"postal_code": "630318018",
"telephone_number": "314-741-1600",
"fax_number": "314-741-1677"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1265 GRAHAM RD STE 1",
"city": "FLORISSANT",
"state": "MO",
"postal_code": "630318018",
"telephone_number": "314-741-1600",
"fax_number": "314-741-1677"
}
],
"practiceLocations": [
{
"address_1": "55 Nesbit Dr Ste B",
"address_purpose": "LOCATION",
"city": "Bonne Terre",
"state": "MO",
"postal_code": "636281353",
"country_code": "US",
"telephone_number": "636-937-3337",
"fax_number": "636-931-7671",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2044 Madison Ave Ste 15",
"address_purpose": "LOCATION",
"city": "Granite City",
"state": "IL",
"postal_code": "620404641",
"country_code": "US",
"telephone_number": "314-741-1600",
"fax_number": "314-741-1677",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1400 US Highway 61 Ste 240A",
"address_purpose": "LOCATION",
"city": "Festus",
"state": "MO",
"postal_code": "630284141",
"country_code": "US",
"telephone_number": "636-937-3337",
"fax_number": "636-931-7671",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2 Memorial Dr Ste 201",
"address_purpose": "LOCATION",
"city": "Alton",
"state": "IL",
"postal_code": "620026723",
"country_code": "US",
"telephone_number": "314-741-1600",
"fax_number": "314-741-1677",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "ST LOUIS KIDNEY CARE LLC",
"organizational_subpart": "NO",
"enumeration_date": "2015-11-13",
"last_updated": "2024-07-24",
"certification_date": "2024-07-24",
"status": "A",
"authorized_official_last_name": "VALLE",
"authorized_official_first_name": "RYAN",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "781-699-9362"
},
"taxonomies": [
{
"code": "207RN0300X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine, Nephrology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "455247262-04915-01",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500035811",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Florissant, MO
- Sarah Spring, D.D.S.
- Abigail Coldren Spudich, MS CF-SLP
- SSM Depaul Medical Group, Inc. (DePaul Medical Group at Cross Keys)
- SSM Medical Group, Inc. (SSM Health Medical Group)
- SSM Select Rehab St. Louis, LLC
- St. Elizabeth Healthcare and Rehabilitation Center
- St. Louis College of Pharmacy
- St. Louis JC Vamc
- St. Louis Medical Rehab Group LLC
- St. Sophia Healthcare, LLC (St. Sophia Health & Rehab Center)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2024; 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.