Individual provider Active NPI

Nicholas Gourtzelis, MD

  • Nephrology Physician
  • Saint Louis, MO
National Provider Identifier
1790734994
Registry record updated Jan 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
2005006931 Issued in MO
Practice address
10004 Kennerly Rd
Ste 374B
St Louis, MO 63128
Phone
(314) 842-9669
Fax
(314) 842-1017
NPI assigned
May 8, 2006
Last updated
Jan 22, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 2005006931 MO Primary

Addresses

Primary practice location

10004 Kennerly Rd
Ste 374B
St Louis, MO 63128

Mailing address

PO Box 802841
Kansas City, MO 64180-2841
Phone (314) 842-9669

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050606000048 MO Practitioner - Nephrology 5496798076 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
NHS South LLCGroup PAC ID 1658797246, 9 clinicians

Practice addresses (Care Compare)

10004 Kennerly Rd
Suite 374B
Saint Louis, MO 63128-2141

10004 Kennerly Rd
Suite 374B
Saint Louis, MO 63128-2178
Phone (314) 842-9669

10010 Kennerly Rd
Saint Louis, MO 63128-2106
Phone (314) 525-1000

102 Richardson Xing
Arnold, MO 63010-6023
Phone (314) 842-9669

11107 S Towne SQ
Saint Louis, MO 63123-7814
Phone (314) 842-9669

11133 Dunn Rd
Saint Louis, MO 63136-6163
Phone (314) 653-5000

12303 Depaul Dr
Bridgeton, MO 63044-2512
Phone (314) 344-6000

12654 Lamplighter SQR Shppng Ctr
Saint Louis, MO 63128-2746
Phone (314) 842-9669

13134 Tesson Ferry Rd
Saint Louis, MO 63128-3806
Phone (314) 842-9669

2194 Michigan Ave
Arnold, MO 63010-2145
Phone (314) 842-9669

6420 Clayton Rd
Richmond Heights, MO 63117-1811
Phone (314) 768-8000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2005006931MOMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
NHS South LLC Nephrology CurrentSince May 22, 2020 Accepting new patients

Locations (25 of 44)

102 Richardson Xing
Arnold, MO 63010
Phone (636) 467-5619

2194 Michigan Ave
Arnold, MO 63010
Phone (636) 287-1160

12380 De Paul Dr
Bridgeton, MO 63044
Phone (314) 447-9700

12380 Natural Bridge Rd
Bridgeton, MO 63044
Phone (314) 344-3001

1224 Graham Rd
Ste 2005
Florissant, MO 63031
Phone (314) 921-7509

13119 New Halls Ferry Rd
Florissant, MO 63033
Phone (314) 383-3252

14001 New Halls Ferry Rd
Ste 133
Florissant, MO 63033
Phone (314) 839-7416

3 Grandview Plaza Shopping Ctr
Florissant, MO 63033
Phone (314) 830-0234

577 Howdershell Rd
Florissant, MO 63031
Phone (314) 831-2178

6811 Parker Rd
Florissant, MO 63033

936 Charbonier Rd
Florissant, MO 63031
Phone (314) 831-4800

637 Dunn Rd
Ste 125
Hazelwood, MO 63042
Phone (314) 731-8039

10951 Saint Charles Rock Rd
Saint Ann, MO 63074
Phone (314) 739-4691

10004 Kennerly Rd
Saint Louis, MO 63128
Phone (314) 525-4100

10004 Kennerly Rd
Ste 374B
Saint Louis, MO 63128
Phone (314) 294-9210

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

10241 Lewis and Clark Blvd
Saint Louis, MO 63136
Phone (314) 868-5982

10435 Clayton Rd
Ste 201
Saint Louis, MO 63131
Phone (314) 567-0645

10887 West Florissant Ave
Saint Louis, MO 63136
Phone (314) 524-5737

11107 S Towne Sq
Saint Louis, MO 63123
Phone (314) 849-3400

11133 Dunn Rd
Saint Louis, MO 63136
Phone (314) 653-5000

12654 Lamplighter Square Shpg Ctr
Saint Louis, MO 63128
Phone (314) 729-7979

13134 Tesson Ferry Rd
Saint Louis, MO 63128
Phone (314) 843-7390

1425 Hampton Ave
Saint Louis, MO 63139
Phone (314) 781-4022

1554 Sierra Vista Plz
Saint Louis, MO 63138
Phone (314) 438-0864

Organizations & group practices 1

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 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1147046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705881600000",
    "number": "1790734994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 802841",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641802841",
            "telephone_number": "314-842-9669",
            "fax_number": "314-842-1017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10004 KENNERLY RD",
            "address_2": "STE 374B",
            "city": "ST LOUIS",
            "state": "MO",
            "postal_code": "63128",
            "telephone_number": "314-842-9669",
            "fax_number": "314-842-1017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOURTZELIS",
        "first_name": "NICHOLAS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-08",
        "last_updated": "2024-01-22",
        "certification_date": "2024-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "MO",
            "license": "2005006931",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.