Individual provider Active NPI

Mesfin Teshome Mitike, M.D.

  • Neurology Physician
  • Saint Louis, MO
National Provider Identifier
1992967632
Registry record updated Nov 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
2008013709 Issued in MO
Practice address
1035 Bellevue Ave
Suite 500
Saint Louis, MO 63117-1854
Phone
(314) 925-4744
Fax
(314) 925-4764
NPI assigned
Jun 25, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Sleep Medicine (Psychiatry & Neurology) Physician 2084S0012X 2012011854 MO
Neurology Physician 2084N0400X 2008013709 MO Primary

Addresses

Primary practice location

1035 Bellevue Ave
Suite 500
Saint Louis, MO 63117-1854

Mailing address

PO Box 955534
Saint Louis, MO 63195-5534

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address mmitike92155@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
I20131009002122 MO Practitioner - NeurologyPractitioner - Sleep Medicine 7911131784 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NeurologyAlso: Sleep Medicine
Education
Washington University School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
SSM Medical Group IncGroup PAC ID 6608776299, 565 clinicians

Practice addresses (Care Compare)

1011 Bowles Ave
Fenton, MO 63026-2387

1035 Bellevue Ave
Suite 500
Saint Louis, MO 63117-1843
Phone (314) 925-4770

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2008013709MOMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
SSM Medical Group, Inc. CurrentSince Aug 1, 2013 Accepting new patients
SSM Medical Group Inc. CurrentSince Aug 1, 2013 Accepting new patients
SSM Health Care St. Louis Past Accepting new patients

Locations

1011 Bowles Ave
Ste 300
Fenton, MO 63026
Phone (636) 496-5000

1551 Wall St
Ste 310
Saint Charles, MO 63303
Phone (636) 669-2268

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

Interoperability endpoints

  • Direct secure messaging: mmitike92155@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 3

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": "1214352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606089600000",
    "number": "1992967632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 955534",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631955534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1035 BELLEVUE AVE",
            "address_2": "SUITE 500",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631171854",
            "telephone_number": "314-925-4744",
            "fax_number": "314-925-4764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITIKE",
        "first_name": "MESFIN",
        "middle_name": "TESHOME",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-25",
        "last_updated": "2020-11-23",
        "certification_date": "2020-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084S0012X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Sleep Medicine",
            "state": "MO",
            "license": "2012011854",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MO",
            "license": "2008013709",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mmitike92155@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "mmitike92155@direct-ehr-ssmhc.com",
            "address_1": "1035 Bellevue Ave",
            "address_2": "Suite 500",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631171854",
            "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": "1035 Bellevue Ave",
            "address_2": "Suite 500",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631171854",
            "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.