NPIMap

Individual provider Active NPI

Jacqueline Fairchild, MD

  • Internal Medicine Physician
  • Saint Louis, MO
National Provider Identifier
1912014184
Registry record updated Mar 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2007022721 Issued in MO
Practice address
11709 Old Ballas Rd Ste 101
Saint Louis, MO 63141-7029
Phone
(314) 993-1200
Fax
(314) 993-1240
NPI assigned
Aug 24, 2006
Last updated
Mar 11, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 2007022721 MO Primary

Addresses

Primary practice location

11709 Old Ballas Rd Ste 101
Saint Louis, MO 63141-7029

Mailing address

11709 Old Ballas Rd Ste 101
Saint Louis, MO 63141-7029
Phone (314) 993-1200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.
Opted out of Medicare
Yes, effective Apr 1, 2024 through Apr 1, 2028

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Hospitalist
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aging Well Health Care, LLCGroup PAC ID 1153232038, 236 clinicians

Practice addresses (Care Compare)

7212 Balson Ave
Saint Louis, MO 63130-3001

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Anthony's Physician Group Internal Medicine Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: jfairchild2998@directc.mercy.net

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1156377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710115200000",
    "number": "1912014184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11709 OLD BALLAS RD STE 101",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631417029",
            "telephone_number": "314-993-1200",
            "fax_number": "314-993-1240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11709 OLD BALLAS RD STE 101",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631417029",
            "telephone_number": "314-993-1200",
            "fax_number": "314-993-1240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAIRCHILD",
        "first_name": "JACQUELINE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-24",
        "last_updated": "2024-03-11",
        "certification_date": "2024-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2007022721",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.