Active NPI
Shivi Yadava, DO
- Family Medicine Physician
- Saint Louis, MO
National Provider Identifier
1992365092
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 2019021551
- Practice address
- 12680 Olive Blvd Ste 300
Saint Louis, MO 63141-6322 - Phone
- (314) 251-8888
- Fax
- (314) 251-8889
- NPI assigned
- Jun 19, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 2019021551 | MO | Primary |
Addresses
Primary practice location
12680 Olive Blvd Ste 300
Saint Louis, MO 63141-6322
Mailing address
12680 Olive Blvd Ste 300
Saint Louis, MO 63141-6322
Phone (314) 251-8888
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jun 12, 2023 through Jun 12, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1560902400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560902400000",
"number": "1992365092",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12680 OLIVE BLVD STE 300",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631416322",
"telephone_number": "314-251-8888",
"fax_number": "314-251-8889"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12680 OLIVE BLVD STE 300",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631416322",
"telephone_number": "314-251-8888",
"fax_number": "314-251-8889"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YADAVA",
"first_name": "SHIVI",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-06-19",
"last_updated": "2019-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": "MO",
"license": "2019021551",
"primary": true
}
],
"identifiers": [],
"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 Jun 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.