Active NPI
St Louis Cardiology Consultants LTD
- Cardiovascular Disease Physician
- Alton, IL
National Provider Identifier
1801831045
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cardiovascular Disease Physician
- Legal business name
- ST LOUIS CARDIOLOGY CONSULTANTS LTD
- Practice address
- 2 Memorial Dr Ste 106
Alton, IL 62002-6723 - Phone
- (618) 433-1861
- Fax
- (618) 433-9274
- NPI assigned
- Jun 19, 2006
- Last updated
- Aug 11, 2021
- 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
- Dr. Samer Thanavaro, MD
- Title
- MD
- Phone
- (618) 433-1861
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | NU | Primary | |
| Interventional Cardiology Physician | 207RI0011X | NU |
Addresses
Primary practice location
2 Memorial Dr Ste 106
Alton, IL 62002-6723
Mailing address
2 Memorial Dr Ste 106
Alton, IL 62002-6723
Phone (618) 433-1861
Other identifiers 9
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C50434 | Other | MO | MORRMCR |
| 2629958 | Other | IL | BC/BS |
| 3831 | Other | CMR / GHP | |
| 1020549 | Other | CAREPARTNERS | |
| CJ3315 | Other | IL | ILRRMCR |
| 219678300 | Other | OWCP | |
| 500347406 | Medicaid | MO | |
| 8816 | Other | HC USA | |
| 30946 | Other | HEALTH PARTNERS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
National Provider Directory
National Provider DirectoryLocations
261 Dunn Rd
Florissant, MO 63031
Phone (314) 270-9446
100 Medical Plz
Ste 1200
Lake St Louis, MO 63367
Phone (636) 755-3133
11133 Dunn Rd
Ste 2346
Saint Louis, MO 63136
Phone (314) 653-5125
Practitioners & affiliated clinicians
Practitioners 19
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.
-
- Family Nurse Practitioner
- Saint Louis, MO
- NPI 1366096703
IL
-
- Cardiovascular Disease Physician
- Springfield, IL
- NPI 1629051958
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150675200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1628640000000",
"number": "1801831045",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 MEMORIAL DR STE 106",
"city": "ALTON",
"state": "IL",
"postal_code": "620026723",
"telephone_number": "618-433-1861",
"fax_number": "618-433-9274"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 MEMORIAL DR STE 106",
"city": "ALTON",
"state": "IL",
"postal_code": "620026723",
"telephone_number": "618-433-1861",
"fax_number": "618-433-9274"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ST LOUIS CARDIOLOGY CONSULTANTS LTD",
"organizational_subpart": "NO",
"enumeration_date": "2006-06-19",
"last_updated": "2021-08-11",
"certification_date": "2021-08-11",
"status": "A",
"authorized_official_last_name": "THANAVARO",
"authorized_official_first_name": "SAMER",
"authorized_official_title_or_position": "MD",
"authorized_official_telephone_number": "618-433-1861",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "NU",
"license": null,
"primary": true
},
{
"code": "207RI0011X",
"taxonomy_group": "",
"desc": "Internal Medicine, Interventional Cardiology",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MORRMCR",
"identifier": "C50434",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS",
"identifier": "2629958",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CMR / GHP",
"identifier": "3831",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAREPARTNERS",
"identifier": "1020549",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ILRRMCR",
"identifier": "CJ3315",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OWCP",
"identifier": "219678300",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500347406",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HC USA",
"identifier": "8816",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PARTNERS",
"identifier": "30946",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Alton, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2021; 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.