Dr Gautam Datta, MD | |
763 S New Ballas Rd, Suite 110, Saint Louis, MO 63141-8704 | |
(314) 843-4333 | |
(314) 843-4856 |
Full Name | Dr Gautam Datta |
---|---|
Gender | Male |
Speciality | Psychiatry |
Experience | 22 Years |
Location | 763 S New Ballas Rd, Saint Louis, Missouri |
Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
Identifier | Type | State | Issuer |
---|---|---|---|
1568688414 | NPI | - | NPPES |
209908706 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
2084P0800X | Psychiatry & Neurology - Psychiatry | 35087615 (Ohio) | Secondary |
2084P0800X | Psychiatry & Neurology - Psychiatry | 2007008850 (Missouri) | Primary |
Facility Name | Location | Facility Type |
---|---|---|
Gateway Regional Medical Center | Granite city, IL | Hospital |
Group Practice Name | Group PECOS PAC ID | No. of Members |
---|---|---|
Ahs Il Medical Group Llc | 5496111676 | 55 |
Entity Name | Ahs Il Medical Group Llc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1659098101 PECOS PAC ID: 5496111676 Enrollment ID: O20230512001300 |
Mailing Address | Practice Location Address |
---|---|
Dr Gautam Datta, MD 5000 Cedar Plaza Pkwy, Suite 350, Saint Louis, MO 63128-3854 Ph: (314) 843-4333 | Dr Gautam Datta, MD 763 S New Ballas Rd, Suite 110, Saint Louis, MO 63141-8704 Ph: (314) 843-4333 |
Dr. Lauren Flynn, M.D. Psychiatry & Neurology Medicare: Not Enrolled in Medicare Practice Location: 231 W Lockwood Ave, Suite 202, Saint Louis, MO 63119 Phone: 314-737-4070 | |
Dr. Antonina S Gesmundo, MD Psychiatry & Neurology Medicare: Medicare Enrolled Practice Location: 1 Jefferson Barracks Dr, Saint Louis, MO 63125 Phone: 314-894-6636 | |
Mr. Robert Harry Brady, M.D. Psychiatry & Neurology Medicare: Accepting Medicare Assignments Practice Location: 1430 Olive St, Suite 500, Saint Louis, MO 63103 Phone: 314-206-3724 Fax: 314-206-3708 | |
Dr. Marcus E Raichle, MD Psychiatry & Neurology Medicare: Not Enrolled in Medicare Practice Location: 517 S Euclid Ave, Ground Floor, Saint Louis, MO 63110 Phone: 314-362-6907 Fax: 314-747-3258 | |
Rohit Pawar, M.D. Psychiatry & Neurology Medicare: Accepting Medicare Assignments Practice Location: 10018 Kennerly Rd, Saint Louis, MO 63128 Phone: 314-525-7275 Fax: 314-525-7260 | |
Dr. Rushaniya Albeptovna Khairova, MD Psychiatry & Neurology Medicare: Accepting Medicare Assignments Practice Location: 24 S Kingshighway Blvd, Saint Louis, MO 63108 Phone: 314-286-1700 Fax: 314-286-1730 | |
Dr. Alyssa E Smith, MD Psychiatry & Neurology Medicare: Medicare Enrolled Practice Location: 1 Childrens Pl, Div Neurology Pediatrics, Saint Louis, MO 63110 Phone: 314-362-1408 Fax: 314-454-2523 |