Michael Scott Boedefeld, MD
Individual provider Active NPI Pain Medicine (Anesthesiology) Physician · Fenton, MO
NPI 1043299548 · NPPES record last updated Oct 20, 2020
Key facts
- NPI
- 1043299548
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pain Medicine (Anesthesiology) Physician 207LP2900X
- License
- 2004009978 (MO)
- Practice address
- 1055 Bowles Ave Ste 202
Fenton, MO 63026-2308 - Phone
- (636) 386-7222
- Fax
- (636) 386-7810
- NPI assigned
- Jan 12, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 13
Hospital & facility affiliations 7
Medicare Care Compare profile
- Specialty
- Interventional Pain Management
- Education
- Creighton University School of Medicine, 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- SSM Medical Group Inc
Pro Pain LLC
Practice addresses (Care Compare)
100 Medical PLZ
Lake Saint Louis, MO 63367-1366
Phone (636) 625-5200
1015 Bowles Ave
Fenton, MO 63026-2394
Phone (636) 496-2000
1035 Bellevue Ave
Suite 500
Saint Louis, MO 63117-1843
Phone (314) 925-4770
114 Piper Hill Dr
Suite 103
Saint Peters, MO 63376-1661
Phone (636) 442-5035
500 Medical Dr
Wentzville, MO 63385-3421
Phone (636) 327-1000
Hospital & facility affiliations
- SSM St Clare Health Center
- SSM St Joseph Health Center
- St Lukes Hospital
- Mercy Hospital St Louis
- Barnes-Jewish St Peters Hospital
- SSM Health Rehabilitation Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Spinal fusion | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- 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 |
|---|---|---|---|---|
| I20050516000089 | MO | Practitioner - Interventional Pain Management |
2567403066 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2004009978 | MO | MD | Pain Medicine (Anesthesiology) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Physicians Ambulatory Surgery Center LLC | Pain Medicine | Current |
Accepting new patients |
| Pro Pain LLC | Pain Medicine | Current |
Accepting new patients |
| SSM Medical Group Inc. | Current |
Accepting new patients | |
| SSM Medical Group, Inc. | Current |
Accepting new patients | |
| Pro Pain LLC | Current |
Accepting new patients | |
| SSM St Clare Surgical Center LLC | Past |
Accepting new patients |
Locations
1055 Bowles Ave
Ste 200
Fenton, MO 63026
Phone (636) 496-3900
1055 Bowles Ave
Ste 202
Fenton, MO 63026
Phone (636) 326-7821
1015 Bowles Ave
Fenton, MO 63026
Phone (636) 496-2000
1551 Wall St
Ste 310
Saint Charles, MO 63303
Phone (636) 669-2268
1035 Bellevue Ave
Ste 500
Saint Louis, MO 63117
Phone (314) 647-1115
3555 Sunset Office Dr
Ste C100
Saint Louis, MO 63127
Phone (314) 238-9100
114 Piper Hill Dr
Ste 201
Saint Peters, MO 63376
Phone (314) 690-1525
114 Piper Hill Dr
Ste 101
Saint Peters, MO 63376
Phone (636) 706-0560
4800 Mexico Rd
Ste 101
Saint Peters, MO 63376
Phone (636) 442-5035
114 Piper Hill Dr
Ste 103
Saint Peters, MO 63376
Phone (314) 308-5009
Interoperability endpoints
- mboedefeld17681@direct-ehr-ssmhc.com
- https://fhir4.healow.com/fhir/r4/DBHJAA/Endpoint/DBHJAA
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 2004009978 | MO | |
| Pain Medicine (Anesthesiology) Physician | 207LP2900X | 2004009978 | MO | Yes |
Addresses
Primary practice location
1055 Bowles Ave Ste 202
Fenton, MO 63026-2308
Mailing address
4800 Mexico Rd Ste 101
Saint Peters, MO 63376-1666
Phone (636) 442-5035
Other practice location 1
4800 Mexico Rd Ste 101
Saint Peters, MO 63376-1666
Phone (636) 442-5035
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 207320102 | Medicaid | MO |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| FHIR URL | https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ | Other | |
| Direct Messaging Address | mboedefeld17681@direct-ehr-ssmhc.com | Direct |
Other providers in Fenton, MO
- Joseph A. Blaes
- Danielle Rebecca Blake
- April Louise Blandford
- Diane Denise Block
- Kellie L Blow
- Emily Bohnert
- Bon Vivant Adult Day Club L.L.C.
- Susan Elizabeth Bonk
- Nicole M Book
- Melanie Marie Boon
All providers in Fenton, MO · Pain Medicine (Anesthesiology) 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 Oct 20, 2020. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.