Individual provider Active NPI

Sunil Gangwani, M.D.

  • Psychiatry Physician
  • Chesterfield, MO
National Provider Identifier
1902004203
Registry record updated Apr 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
2017030250 Issued in MO
Practice address
1176 Town and Country Commons Dr
Chesterfield, MO 63017-8200
Phone
(314) 251-2870
Fax
(314) 251-2871
NPI assigned
Jul 7, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 2007012480 MO
Psychiatry Physician 2084P0800X 036-126918 IL
Psychiatry Physician 2084P0800X 2017030250 MO Primary

Addresses

Primary practice location

1176 Town and Country Commons Dr
Chesterfield, MO 63017-8200

Mailing address

1176 Town and Country Commons Dr
Chesterfield, MO 63017-8200
Phone (314) 251-2870

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
I20200122000883 MO Practitioner - Psychiatry 5294905519 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mercy Clinic Adult Psychiatry LLCGroup PAC ID 4688998602, 15 clinicians

Practice addresses (Care Compare)

12125 Conway Rd
Suite 160
Saint Louis, MO 63141-8241
Phone (314) 251-2870

Hospital & facility affiliations

  • Mercy Hospital St Louis Hospital, Saint Louis, MO, CCN 260020

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-126918ILMDPsychiatry Physician
2007012480MOMDPsychiatry Physician
2017030250MOMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Hospital Perry Current Accepting new patients
Mercy Clinic Adult Psychiatry, LLC Psychiatry CurrentSince Jan 6, 2020 Accepting new patients
Mercy Hospital Perry CurrentSince Dec 13, 2024 Accepting new patients

Locations

434 N West St
Perryville, MO 63775
Phone (573) 547-2530

212 Hospital Ln
Ste 205
Perryville, MO 63775
Phone (573) 547-3116

12125 Conway Rd
Ste 160
Saint Louis, MO 63141
Phone (314) 251-2870

1176 Town and Country Commons Dr
Town and Country, MO 63017
Phone (636) 207-2200

Organizations & group practices 3

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": "1183766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680566400000",
    "number": "1902004203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1176 TOWN AND COUNTRY COMMONS DR",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630178200",
            "telephone_number": "314-251-2870",
            "fax_number": "314-251-2871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1176 TOWN AND COUNTRY COMMONS DR",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630178200",
            "telephone_number": "314-251-2870",
            "fax_number": "314-251-2871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANGWANI",
        "first_name": "SUNIL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-07",
        "last_updated": "2023-04-04",
        "certification_date": "2021-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MO",
            "license": "2007012480",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036-126918",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MO",
            "license": "2017030250",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chesterfield, MO

Sources for this page

Verify at the official NPI Registry.