NPIMap

Organization Active NPI

David J. Pernikoff, MD, PC

  • Internal Medicine Physician
  • Saint Louis, MO
National Provider Identifier
1952596314
Registry record updated Feb 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MO36099 Issued in MO
Legal business name
DAVID J. PERNIKOFF, MD, PC
Practice address
2865 Netherton Dr
Saint Louis, MO 63136-4674
Phone
(314) 653-1600
NPI assigned
Sep 10, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2008

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

Authorized official

Name
David J. Pernikoff, M.D.NPI 1205820594
Title
President
Phone
(314) 653-1600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X MO36099 MO Primary

Addresses

Primary practice location

2865 Netherton Dr
Saint Louis, MO 63136-4674

Mailing address

PO Box 419161
Creve Coeur, MO 63141-9141
Phone (314) 432-2580

Other identifiers 2

IdentifierTypeStateIssuer
506345107MedicaidMO
DG4189OtherMORAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071106000572 MO Part B Supplier - Clinic/Group Practice 7618064775 Receives reassigned benefits from 7 practitioners
Practice locations: Florissant, MO; St Louis, MO; Bridgeton, MO

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1189382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203638400000",
    "number": "1952596314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 419161",
            "city": "CREVE COEUR",
            "state": "MO",
            "postal_code": "631419141",
            "telephone_number": "314-432-2580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2865 NETHERTON DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631364674",
            "telephone_number": "314-653-1600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID J. PERNIKOFF, MD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-10",
        "last_updated": "2008-02-22",
        "status": "A",
        "authorized_official_last_name": "PERNIKOFF",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "314-653-1600",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "MO36099",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "506345107",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DG4189",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.