Individual provider Active NPI

Nicholas Peter Taraska, MD

  • Hospitalist Physician
  • Saint Louis, MO
National Provider Identifier
1841318052
Registry record updated Feb 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
2009022391 Issued in MO
Practice address
11133 Dunn Rd Ste 2427
Saint Louis, MO 63136-6163
Phone
(314) 653-5643
Fax
(314) 653-5648
NPI assigned
Mar 26, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 01070118A IN
Hospitalist Physician 208M00000X 2009022391 MO Primary

Addresses

Primary practice location

11133 Dunn Rd Ste 2427
Saint Louis, MO 63136-6163

Mailing address

11133 Dunn Rd Ste 2427
Saint Louis, MO 63136-6163
Phone (314) 653-5643

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Health Information Exchange (HIE)

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110615000099 MO Practitioner - HospitalistPractitioner - Internal Medicine 8628255825 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hospitalist
Education
Vanderbilt University School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physician Groups LCGroup PAC ID 3072421254, 526 clinicians

Practice addresses (Care Compare)

1110 Highlands Plaza Dr E
Saint Louis, MO 63110-1351
Phone (314) 273-0195

11133 Dunn Rd
Suite 2427
Saint Louis, MO 63136-6163
Phone (314) 653-5643

2630 Hwy K
O Fallon, MO 63368-6624
Phone (636) 240-5454

Hospital & facility affiliations

  • Christian Hospital Northeast Hospital, Saint Louis, MO, CCN 260180

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01070118AINMDNephrology Physician
2009022391MOMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Physician Groups LC Nephrology CurrentSince Oct 23, 2017 Accepting new patients
Physician Groups LC CurrentSince Oct 23, 2017 Accepting new patients

Locations

2630 Highway K
O Fallon, MO 63368
Phone (636) 240-5454

11133 Dunn Rd
Ste 2427
Saint Louis, MO 63136
Phone (314) 653-5643

Interoperability endpoints

  • Direct secure messaging: ntaraska154587@direct.carenet.org
  • Direct secure messaging: nicholastaraska@ena.allscriptsdirect.net

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 and National Provider Directory roles.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614470400000",
    "number": "1841318052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11133 DUNN RD STE 2427",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631366163",
            "telephone_number": "314-653-5643",
            "fax_number": "314-653-5648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11133 DUNN RD STE 2427",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631366163",
            "telephone_number": "314-653-5643",
            "fax_number": "314-653-5648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TARASKA",
        "first_name": "NICHOLAS",
        "middle_name": "PETER",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-26",
        "last_updated": "2021-02-28",
        "certification_date": "2021-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "IN",
            "license": "01070118A",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MO",
            "license": "2009022391",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "11133 Dunn Rd Ste 2427",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631366163",
            "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.