Individual provider Active NPI

Praveena Uppal, M.D.

  • Pulmonary Disease Physician
  • Saint Louis, MO
National Provider Identifier
1871586156
Registry record updated Oct 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
2006024933 Issued in MO
Practice address
11155 Dunn Rd
Ste 315E
Saint Louis, MO 63136-6150
Phone
(314) 355-7500
Fax
(314) 355-3287
NPI assigned
Aug 23, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X 2006024933 MO Primary

Addresses

Primary practice location

11155 Dunn Rd
Ste 315E
Saint Louis, MO 63136-6150

Mailing address

PO Box 955534
Saint Louis, MO 63195-5534

Other practice location 1

12255 De Paul Dr Ste 500
Bridgeton, MO 63044-2515
Phone (314) 209-5180

Other identifiers 2

IdentifierTypeStateIssuer
277060OtherVAANTHEM
005871557MedicaidVA

Other names 1

  • Praveena Uppal IX Professional name

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address puppal21847@direct-ehr-ssmhc.com Direct
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other

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
I20070508000311 MO Practitioner - Pulmonary DiseasePractitioner - Internal Medicine 4385740349 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary DiseaseAlso: Internal Medicine
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SSM Medical Group IncGroup PAC ID 6608776299, 565 clinicians

Practice addresses (Care Compare)

12255 De Paul Dr
Suite 500
Bridgeton, MO 63044-2515
Phone (314) 291-5180

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2006024933MOMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
SSM Medical Group, Inc. Pulmonary Disease CurrentSince Aug 1, 2018 Accepting new patients
SSM Medical Group Inc. CurrentSince Aug 1, 2018 Accepting new patients
SSM Depaul Medical Group, Inc. Past Accepting new patients
Twin County Family Care Centers Inc Past Accepting new patients
SSM Health Care St. Louis Pulmonary Disease Past Accepting new patients

Locations

3221 McKelvey Rd
Ste 301
Bridgeton, MO 63044

12255 De Paul Dr
Ste 500
Bridgeton, MO 63044
Phone (314) 209-5180

1015 Bowles Ave
Fenton, MO 63026
Phone (636) 496-2000

14021 New Halls Ferry Rd
Florissant, MO 63033
Phone (314) 839-0910

3555 Sunset Office Dr
Ste C100
Saint Louis, MO 63127
Phone (314) 238-9100

1035 Bellevue Ave
Ste 500
Saint Louis, MO 63117
Phone (314) 647-1115

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.

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": "1124755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603756800000",
    "number": "1871586156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 955534",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631955534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11155 DUNN RD",
            "address_2": "STE 315E",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631366150",
            "telephone_number": "314-355-7500",
            "fax_number": "314-355-3287"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12255 De Paul Dr Ste 500",
            "address_purpose": "LOCATION",
            "city": "Bridgeton",
            "state": "MO",
            "postal_code": "630442515",
            "country_code": "US",
            "telephone_number": "314-209-5180",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "UPPAL",
        "first_name": "PRAVEENA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-23",
        "last_updated": "2020-10-27",
        "certification_date": "2020-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "MO",
            "license": "2006024933",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "277060",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005871557",
            "state": "VA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "puppal21847@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "puppal21847@direct-ehr-ssmhc.com",
            "address_1": "12255 De Paul Dr Ste 500",
            "city": "Bridgeton",
            "state": "MO",
            "country_code": "US",
            "postal_code": "630442515",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "12255 De Paul Dr Ste 500",
            "city": "Bridgeton",
            "state": "MO",
            "country_code": "US",
            "postal_code": "630442515",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "PRAVEENA",
            "last_name": "UPPAL",
            "suffix": "IX",
            "credential": "M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.