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DR. JUSTIN TYLER DUMRONGKULRAKSA MD
NPI 1568040475
Radiology - Diagnostic Radiology in Saint Louis, MO

Active since March 31, 2021PECOS Enrolled
510 S KINGSHIGHWAY BLVD, DEPT RADIOLOGY, SAINT LOUIS, MO 63110(314) 362-7200(314) 747-4189 Get Directions Write a Review

NPPES record last updated: July 6, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jul 6, 2026, Jul 19, 2021, Mar 31, 2021 (3 updates tracked since 2021).

About Dr. Justin Tyler Dumrongkulraksa Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JUSTIN TYLER DUMRONGKULRAKSA MD (NPI 1568040475) is an individual diagnostic radiology provider in Saint Louis, Missouri, licensed in Missouri (2023012240) and active in the NPI registry since March 2021. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1568040475
Entity TypeIndividualMale
Primary Taxonomy2085R0202X
Provider Legal NameDR. JUSTIN TYLER DUMRONGKULRAKSACredential: MD
Location Address510 S KINGSHIGHWAY BLVD, DEPT RADIOLOGYSaint Louis, MO 63110-1016
Mailing AddressPo Box 7412011Chicago, IL 60674-2011 · (314) 362-7200 · Fax (314) 747-4189
Phone(314) 362-7200
Fax(314) 747-4189
Sole ProprietorNo
Enumeration DateMarch 31, 2021
Last NPPES UpdateJuly 6, 20263 updates tracked since enumeration
NPPES CertifiedJuly 19, 2021
✔ NPI 1568040475 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyRadiology · Diagnostic RadiologyAllopathic & Osteopathic Physicians
Taxonomy Code2085R0202X
License✔ Licensed in MO · 2023012240
Definition
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.
510 S KINGSHIGHWAY BLVD, Saint Louis, MO 63110
Open in Google Maps ↗

Other Identifiers 1

Medicaid200112134MO

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Justin Tyler Dumrongkulraksa Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show Justin Dumrongkulraksa reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Washington University
0.1 mi
Multi-Specialty
510 S KINGSHIGHWAY BLVD
Saint Louis, MO 63110
  • Reassigned Medicare billing, Missouri enrollment
  • 373 clinicians in this Medicare group
NPI 1962442475 (314) 273-0770
Miracl, LLC
95 mi
Multi-Specialty
1000 W 10TH ST
Rolla, MO 65401
  • Reassigned Medicare billing, Missouri enrollment
  • 347 clinicians in this Medicare group
NPI 1205304300 (573) 364-9000

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 63110 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$86.32 typical visit price
range $55.65 – $169.38
Typical copayment $21.58 (range $13.91 – $42.34)
Most-billed visit code 99203
Established Patient
$69.50 typical visit price
range $17.76 – $137.92
Typical copayment $17.37 (range $4.44 – $34.48)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

BENJAMIN LEE MD
Radiology (Neuroradiology)
510 S KINGSHIGHWAY BLVD
SAINT LOUIS, MO 63110
St. Louis City (314) 362-7092
DR. ADRIAN ALBERTO SANCHEZ MD
Radiology (Diagnostic Radiology)
510 S KINGSHIGHWAY BLVD, DEPT RADIOLOGY
SAINT LOUIS, MO 63110
St. Louis City (314) 362-7200
DR. ZIAD WALID TARCHA MD
Radiology (Diagnostic Radiology)
510 S KINGSHIGHWAY BLVD, DEPT RADIOLOGY
SAINT LOUIS, MO 63110
St. Louis City (314) 362-7200
DR. JAMES EDWARD KELLY MD
Radiology (Diagnostic Radiology)
510 S KINGSHIGHWAY BLVD, DEPT RADIOLOGY
SAINT LOUIS, MO 63110
St. Louis City (314) 362-7200
DR. JOSHUA S SHIMONY MD
Radiology (Diagnostic Radiology)
510 S KINGSHIGHWAY BLVD, DEPT RADIOLOGY
SAINT LOUIS, MO 63110
St. Louis City (314) 362-7200
RASHID FUAD AL-SUKAITI MD
Radiology (Diagnostic Radiology)
510 S KINGSHIGHWAY BLVD
SAINT LOUIS, MO 63110
St. Louis City (314) 362-7092
DR. ANDREW THOMAS GREER MD
Radiology (Diagnostic Radiology)
510 S KINGSHIGHWAY BLVD, DEPT RADIOLOGY
SAINT LOUIS, MO 63110
St. Louis City (314) 362-7200
DR. GHAZAL SHADMANI MD
Radiology (Diagnostic Radiology)
510 S KINGSHIGHWAY BLVD, DEPT RADIOLOGY
SAINT LOUIS, MO 63110
St. Louis City (314) 362-7200

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Justin Dumrongkulraksa's NPI number?

The NPI number for Justin Dumrongkulraksa is 1568040475. It was assigned to this individual provider in the NPPES registry on March 31, 2021.

Where is Justin Dumrongkulraksa located?

Justin Dumrongkulraksa practices at 510 S Kingshighway Blvd Dept Radiology, Saint Louis, MO 63110. The listed phone number is (314) 362-7200.

What is Justin Dumrongkulraksa's specialty?

The primary specialty registered for this NPI is Radiology, specializing in Diagnostic Radiology, with taxonomy code 2085R0202X.

Is Justin Dumrongkulraksa enrolled in Medicare?

Yes. Justin Dumrongkulraksa is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Justin Dumrongkulraksa's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Justin Dumrongkulraksa reassigns Medicare benefits to 2 organizations: Washington University (Saint Louis, MO) and Miracl, LLC (Rolla, MO). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Justin Dumrongkulraksa's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Justin Dumrongkulraksa accept?

Health plans from Anthem Blue Cross and Blue Shield list Justin Dumrongkulraksa as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Justin Dumrongkulraksa was last updated on July 6, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.