NPIMap

Individual provider Active NPI

Richard G Mrad, M.D.

  • Internal Medicine Physician
  • Saint Louis, MO
National Provider Identifier
1972573715
Registry record updated Jun 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
R3G47 Issued in MO
Practice address
10010 Kennerly Rd
Saint Louis, MO 63128-2106
Phone
(314) 317-0600
Fax
(314) 317-0606
NPI assigned
Jan 24, 2006
Last updated
Jun 13, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X R3G47 MO Primary
Hospitalist Physician 208M00000X R3G47 MO

Addresses

Primary practice location

10010 Kennerly Rd
Saint Louis, MO 63128-2106

Mailing address

12125 Woodcrest Executive Dr
Suite 220
Saint Louis, MO 63141-5001
Phone (314) 317-0600

Other identifiers 1

IdentifierTypeStateIssuer
1972573715MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040910000411 MO Practitioner - Internal Medicine 4587631502 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Saint Louis University School of Medicine, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

10010 Kennerly Rd
Saint Louis, MO 63128-2106
Phone (314) 525-1899

10018 Kennerly Rd
Saint Louis, MO 63128-2106
Phone (314) 525-3423

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R3G47MOMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Anthonys Physician Organization Hospitalist Services, L.C. Hospitalist CurrentSince Feb 1, 2015 Accepting new patients
Midwest Medicine Group, LLC Internal Medicine CurrentSince Jan 2, 2020 Accepting new patients
St Anthonys Physician Organization Hospitalist Services, L.C. Hospitalist CurrentSince Feb 1, 2015 Accepting new patients
Garden View Care Center, Inc. Past Accepting new patients
Inpatient Consultants of Missouri Inc Internal Medicine Past Accepting new patients
Sanjay a. Patwardhan, MD, PC Internal Medicine Past Accepting new patients
Alliance Inpatient Medicine Inc Hospitalist Past Accepting new patients

Locations

167 Lamp and Lantern Vlg
Chesterfield, MO 63017
Phone (314) 729-1717

1015 Bowles Ave
Fenton, MO 63026
Phone (636) 496-2000

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

Organizations & group practices 7

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": "1138060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339545600000",
    "number": "1972573715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12125 WOODCREST EXECUTIVE DR",
            "address_2": "SUITE 220",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631415001",
            "telephone_number": "314-317-0600",
            "fax_number": "314-317-0600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10010 KENNERLY RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631282106",
            "telephone_number": "314-317-0600",
            "fax_number": "314-317-0606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MRAD",
        "first_name": "RICHARD",
        "middle_name": "G",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-24",
        "last_updated": "2012-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "R3G47",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MO",
            "license": "R3G47",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1972573715",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.