Active NPI
Daniel H Lischwe, M.D.
- Family Medicine Physician
- Bridgeton, MO
National Provider Identifier
1871567297
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- R8630
- Practice address
- 12255 De Paul Dr
Suite 600
Bridgeton, MO 63044-2510 - Phone
- (314) 291-1074
- Fax
- (314) 291-0802
- NPI assigned
- Feb 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | R8630 | MO | Primary |
Addresses
Primary practice location
12255 De Paul Dr
Suite 600
Bridgeton, MO 63044-2510
Mailing address
12255 De Paul Dr
Suite 600
Bridgeton, MO 63044-2510
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00055177 | Other | MO | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R8630 | MO | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| SSM Medical Group, Inc. | Past | Accepting new patients | |
| SSM Depaul Medical Group, Inc. | Family Medicine | Past | Accepting new patients |
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.
-
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- Florissant, MO
- NPI 1952312951
-
- Multi-Specialty Clinic/Center
- Fenton, MO
- NPI 1700966207
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139875200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1205452800000",
"number": "1871567297",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12255 DE PAUL DR",
"address_2": "SUITE 600",
"city": "BRIDGETON",
"state": "MO",
"postal_code": "630442510"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12255 DE PAUL DR",
"address_2": "SUITE 600",
"city": "BRIDGETON",
"state": "MO",
"postal_code": "630442510",
"telephone_number": "314-291-1074",
"fax_number": "314-291-0802"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LISCHWE",
"first_name": "DANIEL",
"middle_name": "H",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-14",
"last_updated": "2008-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MO",
"license": "R8630",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00055177",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bridgeton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.