Shulamit Menashe Portnoy, MD

Primary specialty

Neurology with Special Qualifications in Child Neurology PhysicianTaxonomy code 2084N0402X

License

2003001990 Issued in MO

Practice address

1465 S Grand Blvd
St. Louis, MO 63104-1003

Phone

(314) 577-5609

Fax

(314) 268-4028

NPI assigned

Jun 21, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Electronic endpoints 2

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sportnoy25257@direct-ehr-ssmhc.com

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.

• SSM Health Care Group

  • Internal Medicine Physician
  • Saint Louis, MO
  • NPI 1306589544

  Pediatrics

  Medicare reassignment NPD
• SSM Cardinal Glennon Childrens Hospital

  • Pediatrics Physician
  • O Fallon, IL
  • NPI 1174577670

  MO

  Medicare reassignment NPD
• SSM Cardinal Glennon Children'S Hospital

  • Pediatrics Physician
  • Warrenton, MO
  • NPI 1962573212
  NPD
• SSM Health Care Group

  • Dermatopathology Physician
  • Saint Louis, MO
  • NPI 1932844495
  NPD
• Affinia Healthcare

  • Federally Qualified Health Center (FQHC)
  • Saint Louis, MO
  • NPI 1740067719
  NPD (past)
• SSM St. Joseph Endoscopy Center, LLC

  • Clinic/Center
  • Saint Peters, MO
  • NPI 1871536037
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610323200000",
    "number": "1033115589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 503900",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631503900",
            "telephone_number": "314-577-5609",
            "fax_number": "314-268-4028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1465 S GRAND BLVD",
            "city": "ST. LOUIS",
            "state": "MO",
            "postal_code": "631041003",
            "telephone_number": "314-577-5609",
            "fax_number": "314-268-4028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTNOY",
        "first_name": "SHULAMIT",
        "middle_name": "MENASHE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-21",
        "last_updated": "2021-01-11",
        "certification_date": "2021-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2003001990",
            "primary": false
        },
        {
            "code": "2080P0006X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": "MO",
            "license": "2003001990",
            "primary": false
        },
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "MO",
            "license": "2003001990",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208419606",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sportnoy25257@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "sportnoy25257@direct-ehr-ssmhc.com",
            "address_1": "1465 S Grand Blvd",
            "city": "St. Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631041003",
            "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": "1465 S Grand Blvd",
            "city": "St. Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631041003",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Susan Renee Porter, M.S.W., L.C.S.W.
• Thomas I Porter, OD
• Lisa Porthouse, CNM
• Shellsea Portillo Canales, MD
• Lee S Portnoff, M.D.
• Steven Michael Portnoy, LPC
• Aileen Portugal, MD
• Miranda Portwine, CRNA
• Katherin Elizabeth Portwood, MD
• Kaitlin J Portz, PHD

• Neurology with Special Qualifications in Child Neurology Physician in St. Louis, MO
• Providers in St. Louis, MO by specialty
• Neurology with Special Qualifications in Child Neurology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.