Mark Louis Greenberg, M.D.
Individual provider Active NPI Pediatrics Physician · Frontenac, MO
NPI 1043219967 · NPPES record last updated Apr 20, 2026
Key facts
- NPI
- 1043219967
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- R7G09 (MO)
- Practice address
- 585 Twin Fawns Dr
Frontenac, MO 63131-4717 - Phone
- (602) 561-0367
- NPI assigned
- Jul 21, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 9
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241015000943 | CA | Practitioner - Pediatric Medicine | 8729001607 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21921 | AZ | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Care Health Centers | Current |
Accepting new patients | |
| Siskiyou Hospital, Inc. | Current |
Accepting new patients | |
| Family Care Health Centers | Current |
Accepting new patients | |
| SSM Health Care St. Louis | Past | Accepting new patients | |
| Franciscan Health Crown Point | Past | Accepting new patients | |
| North Scottsdale Pediatric Associates | Pediatrics | Past | Accepting new patients |
| Pleasant Pediatrics PLC | Pediatrics | Past | Accepting new patients |
| JJ Pediatrics, P.L.L.C. | Pediatrics | Past | Accepting new patients |
| Pleasant Pediatrics PLC | Pediatrics | Past | Accepting new patients |
Locations
475 Bruce St
Yreka, CA 96097
Phone (530) 842-3507
444 Bruce St
Yreka, CA 96097
Phone (530) 841-6256
401 Holly Hills Ave
Saint Louis, MO 63111
Phone (314) 353-5190
4352 Manchester Ave
Saint Louis, MO 63110
Phone (314) 371-0336
Interoperability endpoints
- mgreenberg3377098@oc.providencedirect.org
- drgreenberg@mvpkidscare.opdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 21921 | AZ | |
| Pediatrics Physician | 208000000X | R7G09 | MO | Yes |
Addresses
Primary practice location
585 Twin Fawns Dr
Frontenac, MO 63131-4717
Mailing address
585 Twin Fawns Dr
Frontenac, MO 63131-4717
Phone (602) 561-0367
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 418677 | Medicaid | AZ | |
| 200260860 | Medicaid | IN |
Other providers in Frontenac, MO
- Donald Respess, PSYD, LLC
- Ashley Kell Frederic
- Frontenac Ambulatory Surgery & Spine Care Center LP
- Gateway Pain Center Inc
- Darcy Greenberg
- Danielle Marie Hargate
- Ellie Huff
- Gerald Louis Keller Jr.
- Jennifer Kraemer
- Evan Kuhl
All providers in Frontenac, MO · Pediatrics Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 20, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.