Individual provider Active NPI

Aileen Portugal, MD

  • Obstetrics & Gynecology Physician
  • Saint Louis, MO
National Provider Identifier
1821559113
Registry record updated Apr 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
2023025245 Issued in MO
Practice address
4444 Forest Park Ave
Div OB Reproductive Endocrinology, Ste 3100
Saint Louis, MO 63108-2212
Phone
(314) 286-2400
Fax
(314) 286-2455
NPI assigned
Mar 28, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 2023025245 MO Primary

Addresses

Primary practice location

4444 Forest Park Ave
Div OB Reproductive Endocrinology, Ste 3100
Saint Louis, MO 63108-2212

Mailing address

PO Box 7412011
Chicago, IL 60674-2011
Phone (314) 286-2400

Other identifiers 1

IdentifierTypeStateIssuer
200125703MedicaidMO

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Washington University

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
I20230726001792 MO Practitioner - Obstetrics/Gynecology 6002215340 Reassigns benefits to 2 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Missouri Baptist Medical Center CurrentSince Aug 28, 2025 Accepting new patients
Parkway Pathology Group, Inc. Current Accepting new patients
Missouri Baptist Medical Center CurrentSince Aug 28, 2025 Accepting new patients

Locations

3015 N Ballas Rd
Saint Louis, MO 63131
Phone (314) 996-5330

Interoperability endpoints

  • FHIR API: https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1553731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744848000000",
    "number": "1821559113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7412011",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606742011",
            "telephone_number": "314-286-2400",
            "fax_number": "314-286-2455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4444 FOREST PARK AVE",
            "address_2": "DIV OB REPRODUCTIVE ENDOCRINOLOGY, STE 3100",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631082212",
            "telephone_number": "314-286-2400",
            "fax_number": "314-286-2455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTUGAL",
        "first_name": "AILEEN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-28",
        "last_updated": "2025-04-17",
        "certification_date": "2021-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MO",
            "license": "2023025245",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200125703",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "4444 Forest Park Ave",
            "address_2": "Div OB Reproductive Endocrinology, Ste 3100",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631082212",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.