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5669 Delmar Blvd Saint Louis MO 63112-2615 | |
| (314) 531-1770 | |
| (314) 241-1185 |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 5669 Delmar Blvd, Saint Louis, Missouri |
| Authorized Official Name and Position | Mark Sanford (EXECUTIVE VICE PRESIDENT) |
| Authorized Official Contact | 3143677848 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
5701 Delmar Blvd. Saint Louis MO 63112-2617 Ph: (314) 367-7848 | 5669 Delmar Blvd Saint Louis MO 63112-2615 Ph: (314) 531-1770 |
| NPI Number | 1679604318 |
|---|---|
| Provider Enumeration Date | 03/07/2007 |
| Last Update Date | 12/03/2024 |
| Certification Date | 12/03/2024 |
| Medicare PECOS PAC ID | 9739152554 |
|---|---|
| Medicare Enrollment ID | O20060123000591 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679604318 | NPI | - | NPPES |
| 560578007 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Sanjeev Rao |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1386740074 PECOS PAC ID: 7113925272 Enrollment ID: I20061128000156 |
| Provider Name | Syed A Raza |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1871592675 PECOS PAC ID: 8527143502 Enrollment ID: I20100301000034 |
| Provider Name | Marsha D Kempf |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1255332425 PECOS PAC ID: 7911038716 Enrollment ID: I20100622000906 |
| Provider Name | Steven E Kisker |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1801838297 PECOS PAC ID: 2466774393 Enrollment ID: I20141204001082 |
| Provider Name | Vishal K Adma |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1649238221 PECOS PAC ID: 4688576622 Enrollment ID: I20170425002429 |
| Provider Name | Nadeem H Bhatti |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1528259280 PECOS PAC ID: 2163683087 Enrollment ID: I20190128000594 |
| Provider Name | Marsha D Kempf |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255332425 PECOS PAC ID: 7911038716 Enrollment ID: I20190128002515 |
| Provider Name | Jyotsna Adma |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1245457217 PECOS PAC ID: 8224329107 Enrollment ID: I20190308001342 |
| Provider Name | Melinda Michele Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831446863 PECOS PAC ID: 4880844976 Enrollment ID: I20191001002481 |
| Provider Name | Shirin F Bibayan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861927774 PECOS PAC ID: 3375943111 Enrollment ID: I20210615003164 |
| Provider Name | Lakshmi Naveen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1407192131 PECOS PAC ID: 3971805300 Enrollment ID: I20210802000496 |
| Provider Name | Kelsey J Lonergan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871126391 PECOS PAC ID: 1254700271 Enrollment ID: I20221214002523 |
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