David Andrew Wathen, D.O.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

2009008973 Issued in MO

Practice address

1465 S Grand Blvd
St. Louis, MO 63104-1003

Phone

(314) 577-1607

Fax

(314) 268-4112

NPI assigned

Jun 9, 2007

Last updated

Apr 17, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Mercy Hospitals East Communities

  dba Mercy JFK Clinic

  • Clinic/Center
  • Saint Louis, MO
  • NPI 1851431738
  Medicare reassignment NPD
• SSM Health Care Group

  dba SLUCare Physician Group

  • Internal Medicine Physician
  • Saint Louis, MO
  • NPI 1306589544

  Pediatrics

  Medicare reassignment NPD
• Mercy Hospitals East Communities

  dba Mercy St. Louis Transport Ambulance

  • Land Ambulance
  • Saint Louis, MO
  • NPI 1881329902
  NPD
• SSM Health Care Group

  dba SLUCare Physician Group

  • Dermatopathology Physician
  • Saint Louis, MO
  • NPI 1932844495
  NPD
• Mercy Hospitals East Communities

  dba Mercy Hospital St Louis

  • General Acute Care Hospital
  • Saint Louis, MO
  • NPI 1427098169
  NPD (past)
• SSM Cardinal Glennon Children's Hospital

  • Children's Hospital
  • Saint Louis, MO
  • NPI 1508935891
  NPD (past)

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

{
    "created_epoch": "1181347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555459200000",
    "number": "1811190408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1465 S GRAND BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631041003",
            "telephone_number": "314-577-1607",
            "fax_number": "314-268-4112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1465 S GRAND BLVD",
            "city": "ST. LOUIS",
            "state": "MO",
            "postal_code": "631041003",
            "telephone_number": "314-577-1607",
            "fax_number": "314-268-4112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATHEN",
        "first_name": "DAVID",
        "middle_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-09",
        "last_updated": "2019-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MO",
            "license": "2009008973",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2009008973",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristen Wymore Waterbury, MD
• Amber Dawn Waters
• Charlene Waters, PTA
• Decia Waters, RN
• Michael Richard Waters, MD
• Shelley E Watkins-Parker, M.A.
• Cheryl Lavecious Watkins, LPN
• Damonique Watkins
• Garey Lynn Clifford Watkins I, M.D.
• Richard Maurice Watkins Sr., MS,RPH

• Pediatrics Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Pediatrics Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.