NPIMap

Individual provider Active NPI

Lindsay Fairfax, MD

  • Surgical Critical Care Physician
  • Saint Louis, MO
National Provider Identifier
1952512980
Registry record updated Aug 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Critical Care PhysicianTaxonomy code 2086S0102X
License
2022019850 Issued in MO
Practice address
10012 Kennerly Rd Ste 406
Saint Louis, MO 63128-2197
Phone
(314) 525-1224
Fax
(314) 525-4957
NPI assigned
May 24, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2024

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 4301115451 MI
Surgery Physician 208600000X 036140509 IL
Surgery Physician 208600000X 141098 NC
Surgery Physician 208600000X 01091194A IN
Surgical Critical Care Physician 2086S0102X 70272 WI
Surgical Critical Care Physician 2086S0102X 2022019850 MO Primary

Addresses

Primary practice location

10012 Kennerly Rd Ste 406
Saint Louis, MO 63128-2197

Mailing address

10012 Kennerly Rd Ste 406
Saint Louis, MO 63128-2197
Phone (314) 525-1224

Other practice location 1

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 355-3176

Other practice location 2

601 John St # 67
Kalamazoo, MI 49007-5341
Phone (269) 341-6022

Other practice location 3

1900 South Ave
LA Crosse, WI 54601-5467
Phone (608) 782-7300

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address lfairfax107512@ewd.direct.hshs.org Direct St Vincent Hospital-Hospital Sisters-Third Order of St Francis

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, FL, IL, MI, WI, MO6 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 6

Enrollment IDStateProvider typePAC IDDetails
I20140312001692 NC Practitioner - General SurgeryPractitioner - Critical Care (Intensivists) 7113157124 Reassigns benefits to 1 organization
I20160607002395 FL Practitioner - General Surgery 7113157124
I20160826000199 IL Practitioner - General Surgery 7113157124 Reassigns benefits to 1 organization
I20180807003416 MI Practitioner - General Surgery 7113157124 Reassigns benefits to 1 organization
I20190514000008 WI Practitioner - General Surgery 7113157124 Reassigns benefits to 2 organizations
I20240816001423 MO Practitioner - General Surgery 7113157124 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Eastern Virginia Medical School, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gundersen Lutheran Medical Center IncGroup PAC ID 2163331414, 888 clinicians

Practice addresses (Care Compare)

1836 S Ave
La Crosse, WI 54601-5429
Phone (608) 783-7300

Hospital & facility affiliations

  • Gundersen Lutheran Medical Center Hospital, La Crosse, WI, CCN 520087
  • Tomah Memorial Hospital Hospital, Tomah, WI, CCN 521320
  • Crossing Rivers Health Medical Center Hospital, Prairie Du Chien, WI, CCN 521330

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
141098NCMDSurgery Physician
70272WIMDSurgical Critical Care Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bronson Methodist Hospital CurrentSince Jul 1, 2018 Accepting new patients
Gundersen Lutheran Medical Center Inc Current Accepting new patients
Mercy Health System Corporation CurrentSince Apr 30, 2019 Accepting new patients
Rockford Health Physicians CurrentSince Feb 20, 2019 Accepting new patients
Mercy Health System Corporation CurrentSince Apr 30, 2019 Accepting new patients
Gundersen Lutheran Medical Center, Inc CurrentSince May 17, 2021 Accepting new patients
Mercy Clinic Surgical Specialists, LLC Surgery CurrentSince Aug 10, 2024 Accepting new patients
Gundersen Lutheran Medical Center, Inc CurrentSince May 17, 2021 Accepting new patients
MCPC-9, LLC CurrentSince Mar 16, 2015 Accepting new patients
Mission Hospitals Inc Current Accepting new patients
Mercy Clinic East Communities Past Accepting new patients

Locations

29624 Network Pl
Chicago, IL 60673
Phone (608) 741-7652

2300 N Rockton Ave
Rockford, IL 61103
Phone (815) 971-5510

601 John St
#67
Kalamazoo, MI 49007
Phone (269) 341-6022

601 John St
Ste M-124
Kalamazoo, MI 49007
Phone (269) 341-7500

10012 Kennerly Rd
Ste 406
Saint Louis, MO 63128
Phone (314) 525-1224

621 S New Ballas Rd
Ste 3005B
Saint Louis, MO 63141
Phone (314) 251-7070

5 First Village Dr
Pinehurst, NC 28374
Phone (910) 235-2713

510 N Terrace St
Janesville, WI 53548
Phone (608) 756-6869

1000 Mineral Point Ave
Janesville, WI 53548
Phone (608) 261-6868

1836 South Ave
La Crosse, WI 54601
Phone (608) 788-8102

1900 South Ave
La Crosse, WI 54601
Phone (608) 775-2287

1910 South Ave
La Crosse, WI 54601
Phone (608) 775-2287

Interoperability endpoints

  • Direct secure messaging: lfairfax107512@ewd.direct.hshs.org
  • Direct secure messaging: lfairfax516266@direct.emplifyhealth.org
  • Direct secure messaging: lfairfax856527@direct.centracare.com

Organizations & group practices 11

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 9

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": "1179964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723075200000",
    "number": "1952512980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10012 KENNERLY RD STE 406",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631282197",
            "telephone_number": "314-525-1224",
            "fax_number": "314-525-4957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10012 KENNERLY RD STE 406",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631282197",
            "telephone_number": "314-525-1224",
            "fax_number": "314-525-4957"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 Blythe Blvd",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "28203",
            "country_code": "US",
            "telephone_number": "704-355-3176",
            "fax_number": "704-355-7833",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "601 John St # 67",
            "address_purpose": "LOCATION",
            "city": "Kalamazoo",
            "state": "MI",
            "postal_code": "490075341",
            "country_code": "US",
            "telephone_number": "269-341-6022",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1900 South Ave",
            "address_purpose": "LOCATION",
            "city": "LA Crosse",
            "state": "WI",
            "postal_code": "546015467",
            "country_code": "US",
            "telephone_number": "608-782-7300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAIRFAX",
        "first_name": "LINDSAY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-24",
        "last_updated": "2024-08-08",
        "certification_date": "2024-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "4301115451",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036140509",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NC",
            "license": "141098",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IN",
            "license": "01091194A",
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "WI",
            "license": "70272",
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "MO",
            "license": "2022019850",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lfairfax107512@ewd.direct.hshs.org",
            "affiliation": "Y",
            "affiliationName": "St Vincent Hospital-Hospital Sisters-Third Order of St Francis",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "835 S Van Buren St",
            "city": "Green Bay",
            "state": "WI",
            "country_code": "US",
            "postal_code": "543013526",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.