NPIMap

Organization Active NPI

Washington University

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Saint Louis, MO
National Provider Identifier
1871521575
Registry record updated Dec 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
WASHINGTON UNIVERSITY
Practice address
4205 Forest Park Ave
Saint Louis, MO 63108-2810
Phone
(314) 286-0842
NPI assigned
Jun 29, 2006
Last updated
Dec 30, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2015

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

Authorized official

Name
Cathy Eghigian
Title
Director, Credentialing Operations
Phone
(314) 273-0770

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X NU Primary

Addresses

Primary practice location

4205 Forest Park Ave
Saint Louis, MO 63108-2810

Mailing address

4240 Duncan Ave
Campus Box 8221
Saint Louis, MO 63110-1123
Phone (314) 273-0770

Other identifiers 1

IdentifierTypeStateIssuer
500724208MedicaidMO

Other names 1

  • Forest Park Kidney Center Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111229000770 MO Part A Provider - End-Stage Renal Disease Facility (ESRD) 9830008770 Practice locations: Saint Louis, MO

National Provider Directory

National Provider Directory
Tax ID family
Div Orthopedic Surgery81 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 20

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 20

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

4205 Forest Park Ave
Saint Louis, MO 63108
Phone (314) 286-0800

NPI Registry JSON

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1451433600000",
    "number": "1871521575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4240 DUNCAN AVE",
            "address_2": "CAMPUS BOX 8221",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101123",
            "telephone_number": "314-273-0770",
            "fax_number": "314-273-0470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4205 FOREST PARK AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631082810",
            "telephone_number": "314-286-0842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WASHINGTON UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-29",
        "last_updated": "2015-12-30",
        "status": "A",
        "authorized_official_last_name": "EGHIGIAN",
        "authorized_official_first_name": "CATHY",
        "authorized_official_title_or_position": "DIRECTOR, CREDENTIALING OPERATIONS",
        "authorized_official_telephone_number": "314-273-0770"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500724208",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Forest Park Kidney Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2015; 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.

Verify at the official NPI Registry.