St Louis Medical Rehab Group LLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

4301089175 Issued in MI

Legal business name

ST LOUIS MEDICAL REHAB GROUP LLC

Practice address

8045 Big Bend Blvd
Suite 201
Webster Groves, MO 63119-2714

Phone

(314) 443-8667

NPI assigned

Jun 9, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Ahmed Ali, M.D.

Title

Ceo

Phone

(314) 443-8667

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1307577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312502400000",
    "number": "1871888693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8045 BIG BEND BLVD",
            "address_2": "SUITE 201",
            "city": "WEBSTER GROVES",
            "state": "MO",
            "postal_code": "631192714",
            "telephone_number": "314-443-8667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8045 BIG BEND BLVD",
            "address_2": "SUITE 201",
            "city": "WEBSTER GROVES",
            "state": "MO",
            "postal_code": "631192714",
            "telephone_number": "314-443-8667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST LOUIS MEDICAL REHAB GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-09",
        "last_updated": "2011-08-05",
        "status": "A",
        "authorized_official_last_name": "ALI",
        "authorized_official_first_name": "AHMED",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "314-443-8667",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "MI",
            "license": "4301089175",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MI",
            "license": "4301089175",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.