Individual provider Active NPI

Samuel Nathan Jonas, MD

  • Diagnostic Radiology Physician
  • Saint Louis, MO
National Provider Identifier
1851718985
Registry record updated Feb 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
2019009764 Issued in MO
Practice address
510 S Kingshighway Blvd
Saint Louis, MO 63110-1016
Phone
(314) 362-7200
Fax
(314) 747-4189
NPI assigned
Mar 26, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 2019009764 MO Primary

Addresses

Primary practice location

510 S Kingshighway Blvd
Saint Louis, MO 63110-1016

Mailing address

2101 E Jefferson St
Rockville, MD 20852-4908
Phone (202) 579-7105

Other practice location 1

2101 E Jefferson St
Rockville, MD 20852-4908
Phone (202) 579-7105

Other identifiers 2

IdentifierTypeStateIssuer
200067602MedicaidMO
ENROLLEDMedicaidIL

Electronic endpoints 2

TypeEndpointUseAffiliation
SOAP URL https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq Health Information Exchange (HIE)
SOAP URL https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq Health Information Exchange (HIE) Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC, GA, VA4 enrollments
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 4

Enrollment IDStateProvider typePAC IDDetails
I20200828000912 MD Practitioner - Diagnostic Radiology 1850524729 Reassigns benefits to 1 organization
I20200909003071 DC Practitioner - Diagnostic Radiology 1850524729 Reassigns benefits to 1 organization
I20210917001948 GA Practitioner - Diagnostic Radiology 1850524729 Reassigns benefits to 1 organization
I20211220001647 VA Practitioner - Diagnostic Radiology 1850524729 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Maryland School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kaiser Foundation Health Plan of the Mid Atlantic States, IncGroup PAC ID 3779495858, shared by 17 NPIs, 1,921 clinicians

Practice addresses (Care Compare)

10810 Connecticut Ave
Kensington, MD 20895-2138
Phone (301) 929-7100

1221 Mercantile LN
Largo, MD 20774-5374
Phone (301) 618-5700

12255 Fair Lakes Pkwy
Fairfax, VA 22033-3952
Phone (703) 237-4800

1396 Piccard Dr
Rockville, MD 20850-4302
Phone (301) 548-5700

14139 Potomac Mills Rd
Woodbridge, VA 22192-4644
Phone (703) 257-3000

1701 Twin Springs Rd
Halethorpe, MD 21227-3553
Phone (410) 737-5000

1890 Metro Ctr Dr
Reston, VA 20190-5286
Phone (703) 709-1500

201 N Washington St
Falls Church, VA 22046-4518
Phone (703) 237-4000

2301 M St NW
Washington, DC 20037-1427
Phone (202) 419-6200

3000 Potomac Ave
Alexandria, VA 22305-3084
Phone (703) 721-6300

5100 Auth Way
Suitland, MD 20746-4207
Phone (301) 702-5000

5400 Hillmeade Rd
Bowie, MD 20720-4777
Phone (301) 867-1300

6104 Old Branch Ave
Temple Hills, MD 20748-2518
Phone (301) 702-6100

655 Watkins Mill Rd
Gaithersburg, MD 20879-3301
Phone (240) 632-4000

6551 Loisdale CT
Springfield, VA 22150-1828
Phone (703) 922-1000

8008 Westpark Dr
MC Lean, VA 22102-3109
Phone (703) 287-6400

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2019009764MOMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc Diagnostic Radiology CurrentSince Aug 24, 2020 Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc Diagnostic Radiology CurrentSince Oct 1, 2021 Accepting new patients
The Southeast Permanente Medical Group Diagnostic Radiology CurrentSince Aug 1, 2021 Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc Diagnostic Radiology CurrentSince Aug 24, 2020 Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc CurrentSince Aug 24, 2020 Accepting new patients

Locations

3495 Piedmont Rd NE
Bldg 9
Atlanta, GA 30305
Phone (404) 364-7000

2400 Mount Zion Pkwy
Jonesboro, GA 30236
Phone (770) 603-3649

7070 Samuel Morse Dr
Columbia, MD 21046
Phone (410) 309-4600

7190 Crestwood Blvd
Frederick, MD 21703
Phone (240) 529-1700

1701 Twin Springs Rd
Halethorpe, MD 21227
Phone (410) 737-5000

2101 E Jefferson St
Rockville, MD 20852
Phone (301) 816-6660

2101 E Jefferson St
Ste 6WPPQA
Rockville, MD 20852
Phone (301) 816-5853

2101 E Jefferson St
#4E
Rockville, MD 20852

2101 E Jefferson St
Ste 4EAST
Rockville, MD 20852

1221 Mercantile Ln
Upper Marlboro, MD 20774
Phone (301) 618-5500

14139 Potomac Mills Rd
Woodbridge, VA 22192
Phone (703) 257-3000

Organizations & group practices 5

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": "1395792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643932800000",
    "number": "1851718985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 E JEFFERSON ST",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208524908",
            "telephone_number": "202-579-7105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 S KINGSHIGHWAY BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101016",
            "telephone_number": "314-362-7200",
            "fax_number": "314-747-4189"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2101 E Jefferson St",
            "address_purpose": "LOCATION",
            "city": "Rockville",
            "state": "MD",
            "postal_code": "208524908",
            "country_code": "US",
            "telephone_number": "202-579-7105",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JONAS",
        "first_name": "SAMUEL",
        "middle_name": "NATHAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-03-26",
        "last_updated": "2022-02-04",
        "certification_date": "2022-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MO",
            "license": "2019009764",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200067602",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ENROLLED",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "N",
            "endpointDescription": "carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "c-cda",
            "address_1": "1701 Twin Springs Rd",
            "city": "Halethorpe",
            "state": "MD",
            "country_code": "US",
            "postal_code": "212273553",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "2400 Mount Zion Pkwy",
            "city": "Jonesboro",
            "state": "GA",
            "country_code": "US",
            "postal_code": "302362500",
            "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.