Individual provider Active NPI

Mudresh Rajnikant Mehta, MD

  • Hematology & Oncology Physician
  • Saint Louis, MO
National Provider Identifier
1982932083
Registry record updated Jul 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
2016013265 Issued in MO
Practice address
3635 Vista Ave
14 Floor, Desloge Towers
Saint Louis, MO 63110-2539
Phone
(314) 577-8762
NPI assigned
Dec 1, 2009
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X 2016013265 MO Primary

Addresses

Primary practice location

3635 Vista Ave
14 Floor, Desloge Towers
Saint Louis, MO 63110-2539

Mailing address

3635 Vista Ave
14 Floor, Desloge Towers
Saint Louis, MO 63110-2539
Phone (314) 577-8762

Other practice location 1

6400 Clayton Rd Ste 302
Saint Louis, MO 63117-1850
Phone (314) 645-3370

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address mmehta236829@direct-ehr-ssmhc.com Direct
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other

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
I20160902000322 MO Practitioner - Hematology/OncologyPractitioner - Internal Medicine 0143522680 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hematology/Oncology
Education
Mercer University School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SSM Medical Group IncGroup PAC ID 6608776299, 565 clinicians

Practice addresses (Care Compare)

6400 Clayton Rd
Suite 302
Richmond Heights, MO 63117-1850
Phone (314) 645-3370

Hospital & facility affiliations

  • SSM Health St Mary'S Hospital - St Louis Hospital, Saint Louis, MO, CCN 260091
  • SSM St Clare Health Center Hospital, Fenton, MO, CCN 260081
  • SSM Health Saint Louis University Hospital Hospital, Saint Louis, MO, CCN 260105
  • SSM Health Rehabilitation Hospital Inpatient rehabilitation facility, Richmond Heights, MO, CCN 263031

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2016013265MOMDHematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
SSM Medical Group, Inc. Internal Medicine CurrentSince Jul 15, 2020 Accepting new patients
SSM Medical Group Inc. CurrentSince Jul 15, 2020 Accepting new patients
SSM Health Care St. Louis Internal Medicine Past Accepting new patients

Locations

3221 McKelvey Rd
Ste 301
Bridgeton, MO 63044

1011 Bowles Ave
Ste G50
Fenton, MO 63026
Phone (636) 496-4600

1035 Bellevue Ave
Ste 500
Saint Louis, MO 63117
Phone (314) 647-1115

3555 Sunset Office Dr
Ste C100
Saint Louis, MO 63127
Phone (314) 238-9100

3635 Vista Ave
#14
Saint Louis, MO 63110
Phone (314) 577-8762

3635 Vista Ave
Saint Louis, MO 63110
Phone (314) 577-8022

6400 Clayton Rd
Ste 302
Saint Louis, MO 63117
Phone (314) 645-3370

Interoperability endpoints

  • Direct secure messaging: mmehta236829@direct-ehr-ssmhc.com

Organizations & group practices 3

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 5

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": "1259625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720483200000",
    "number": "1982932083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3635 VISTA AVE",
            "address_2": "14 FLOOR, DESLOGE TOWERS",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631102539",
            "telephone_number": "314-577-8762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3635 VISTA AVE",
            "address_2": "14 FLOOR, DESLOGE TOWERS",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631102539",
            "telephone_number": "314-577-8762"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6400 Clayton Rd Ste 302",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631171850",
            "country_code": "US",
            "telephone_number": "314-645-3370",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEHTA",
        "first_name": "MUDRESH",
        "middle_name": "RAJNIKANT",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-12-01",
        "last_updated": "2024-07-09",
        "certification_date": "2024-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "MO",
            "license": "2016013265",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mmehta236829@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "mmehta236829@direct-ehr-ssmhc.com",
            "address_1": "6400 Clayton Rd Ste 302",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631171850",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "6400 Clayton Rd Ste 302",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631171850",
            "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.