Individual provider Active NPI

Iman Abou Assi, RN

  • Registered Nurse
  • Saint Louis, MO
National Provider Identifier
1780889071
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
147949 Issued in MO
Practice address
10012 Kennerly Rd
#301 Gateway Cardiology PC
St Louis, MO 63128
Phone
(314) 729-0088
Fax
(314) 729-3974
NPI assigned
Jun 18, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 147949 MO Primary
Registered Nurse 163W00000X IL

Addresses

Primary practice location

10012 Kennerly Rd
#301 Gateway Cardiology PC
St Louis, MO 63128

Mailing address

11140 S Towne Square
Suite 105
St Louis, MO 63123
Phone (314) 894-0787

Other identifiers 1

IdentifierTypeStateIssuer
147949OtherMORN LIC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
041345333ILMDRegistered Nurse
147949MOMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Gateway Cardiology PC PastSince Jul 15, 1994 Accepting new patients
John P Marino MD LLC Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1182124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1780889071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11140 S TOWNE SQUARE",
            "address_2": "SUITE 105",
            "city": "ST LOUIS",
            "state": "MO",
            "postal_code": "63123",
            "telephone_number": "314-894-0787",
            "fax_number": "314-729-3963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10012 KENNERLY RD",
            "address_2": "#301 GATEWAY CARDIOLOGY PC",
            "city": "ST LOUIS",
            "state": "MO",
            "postal_code": "63128",
            "telephone_number": "314-729-0088",
            "fax_number": "314-729-3974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ASSI",
        "first_name": "IMAN",
        "middle_name": "ABOU",
        "name_prefix": "Ms.",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MO",
            "license": "147949",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RN LIC",
            "identifier": "147949",
            "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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.