NPIMap

Individual provider Active NPI

Priya Kumaraguru, M.D.

  • Family Medicine Physician
  • Alton, IL
National Provider Identifier
1902062862
Registry record updated Mar 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036127459 Issued in IL
Practice address
2 Saint Anthonys Way
Suite 205
Alton, IL 62002-4569
Phone
(618) 462-2222
Fax
(618) 463-5004
NPI assigned
Jul 31, 2008
Last updated
Mar 9, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036127459 IL Primary

Addresses

Primary practice location

2 Saint Anthonys Way
Suite 205
Alton, IL 62002-4569

Mailing address

2 Saint Anthonys Way
Suite 205
Alton, IL 62002-4569
Phone (618) 462-2222

Other practice location 1

9759 Manchester Rd
Saint Louis, MO 63119-1346
Phone (314) 781-4922

Other identifiers 1

IdentifierTypeStateIssuer
P01013993OtherILRAILROAD MEDICARE

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address pkumaraguru437491@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 IL, MO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20111006000076 IL Practitioner - Family Practice 4385816834 Reassigns benefits to 2 organizations
I20221121001036 MO Practitioner - Family Practice 4385816834 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
SSM Medical Group IncGroup PAC ID 6608776299, 565 clinicians

Practice addresses (Care Compare)

9759 Manchester Rd
Saint Louis, MO 63119-1346
Phone (314) 781-4922

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036127459ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
SSM Medical Group Inc. CurrentSince Jan 9, 2022 Accepting new patients
Osf Healthcare System CurrentSince Oct 21, 2020 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
SSM Medical Group, Inc. CurrentSince Jan 9, 2022 Accepting new patients
Osf Healthcare System Current Accepting new patients
Osf Healthcare System CurrentSince Oct 21, 2020 Accepting new patients
Osf Multi-Specialty Group CurrentSince Jan 1, 2016 Accepting new patients
SSM Health Care St. Louis Past Accepting new patients

Locations

2 Saint Anthonys Way
Ste 205
Alton, IL 62002
Phone (618) 462-2222

2 Saint Anthonys Way
Ste 300
Alton, IL 62002
Phone (618) 462-2226

1051 W South St
Kewanee, IL 61443
Phone (309) 734-3141

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

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

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

9759 Manchester Rd
Saint Louis, MO 63119
Phone (314) 781-4922

Interoperability endpoints

  • Direct secure messaging: pkumaraguru437491@direct-ehr-ssmhc.com

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1217462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678320000000",
    "number": "1902062862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 SAINT ANTHONYS WAY",
            "address_2": "SUITE 205",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620024569",
            "telephone_number": "618-462-2222",
            "fax_number": "618-462-1150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 SAINT ANTHONYS WAY",
            "address_2": "SUITE 205",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620024569",
            "telephone_number": "618-462-2222",
            "fax_number": "618-463-5004"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9759 Manchester Rd",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631191346",
            "country_code": "US",
            "telephone_number": "314-781-4922",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KUMARAGURU",
        "first_name": "PRIYA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-31",
        "last_updated": "2023-03-09",
        "certification_date": "2023-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036127459",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01013993",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pkumaraguru437491@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "pkumaraguru437491@direct-ehr-ssmhc.com",
            "address_1": "9759 Manchester Rd",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631191346",
            "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": "9759 Manchester Rd",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631191346",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Alton, IL

Sources for this page

Verify at the official NPI Registry.