Individual provider Active NPI

Shady Hawatmeh

  • Internal Medicine Physician
  • Saint Louis, MO
National Provider Identifier
1922498617
Registry record updated Apr 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2017022834 Issued in MO
Practice address
621 S New Ballas Rd Ste 112a
Saint Louis, MO 63141-8252
Phone
(314) 251-6339
NPI assigned
Feb 2, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 4, 2019

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 2017022834 MO Primary

Addresses

Primary practice location

621 S New Ballas Rd Ste 112a
Saint Louis, MO 63141-8252

Mailing address

9429 Caddyshack Cir
Saint Louis, MO 63127-1937

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
I20170821000203 MO Practitioner - Internal MedicinePractitioner - Hospitalist 8325310725 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Hospitalist
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinic Adult Hospitalists - St. Louis, LLCGroup PAC ID 6002809944, 139 clinicians
Mercy Hospitals East CommunitiesGroup PAC ID 1658276811, 92 clinicians

Practice addresses (Care Compare)

615 S New Ballas Rd
Saint Louis, MO 63141-8221
Phone (314) 251-6339

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Adult Hospitalists - St. Louis, LLC Internal Medicine CurrentSince Aug 20, 2017 Accepting new patients
Mercy Clinic Adult Hospitalists - Washington, LLC CurrentSince Dec 29, 2019 Accepting new patients
St Anthonys Physician Organization Hospitalist Services, L.C. CurrentSince Jan 1, 2018 Accepting new patients
Mercy Hospitals East Communities CurrentSince Aug 20, 2017 Accepting new patients
Mercy Hospital Lincoln Internal Medicine CurrentSince Dec 29, 2019 Accepting new patients
Mercy Hospitals East Communities CurrentSince Aug 20, 2017 Accepting new patients
Mercy Clinic Adult Hospitalists- Jefferson, LLC Internal Medicine CurrentSince Dec 29, 2019 Accepting new patients
Mercy Hospitals East Communities Internal Medicine Past Accepting new patients

Locations

1400 US Highway 61
Crystal Cty, MO 63028
Phone (636) 933-1111

621 S New Ballas Rd
Ste 3016B
Saint Louis, MO 63141
Phone (314) 251-6339

621 S New Ballas Rd
Ste 112A
Saint Louis, MO 63141
Phone (314) 251-6339

615 S New Ballas Rd
Saint Louis, MO 63141
Phone (314) 251-4687

615 S New Ballas Rd
#H
Saint Louis, MO 63141
Phone (314) 251-6075

10010 Kennerly Rd
Saint Louis, MO 63128
Phone (314) 525-1328

900 E Cherry St
Troy, MO 63379
Phone (636) 528-8585

901 E 5th St
Washington, MO 63090
Phone (636) 239-8000

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 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": "1422835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554336000000",
    "number": "1922498617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9429 CADDYSHACK CIR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631271937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 S NEW BALLAS RD STE 112A",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418252",
            "telephone_number": "314-251-6339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAWATMEH",
        "first_name": "SHADY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-02-02",
        "last_updated": "2019-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2017022834",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.