Michael Scott Boedefeld, MD

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

License

2004009978 Issued in 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

Last updated

Oct 20, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Specialty

Interventional Pain ManagementAlso: Anesthesiology

Education

Creighton University School of Medicine, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

SSM Medical Group IncGroup PAC ID 6608776299, 565 clinicians

Pro Pain LLCGroup PAC ID 0941563225, 6 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• SSM St Clare Health Center Hospital, Fenton, MO, CCN 260081
• SSM St Joseph Health Center Hospital, Saint Charles, MO, CCN 260005
• St Lukes Hospital Hospital, Chesterfield, MO, CCN 260179
• Mercy Hospital St Louis Hospital, Saint Louis, MO, CCN 260020
• Barnes-Jewish St Peters Hospital Hospital, Saint Peters, MO, CCN 260191
• SSM Health Rehabilitation Hospital Inpatient rehabilitation facility, Richmond Heights, MO, CCN 263031

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/DBHJAA/Endpoint/DBHJAA
• Direct secure messaging: mboedefeld17681@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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pro Pain LLC

  • Pain Medicine (Anesthesiology) Physician
  • Fenton, MO
  • NPI 1205339074
  Medicare reassignment Care Compare group NPD Authorized official
• SSM Medical Group, Inc.

  dba SSM Health Medical Group

  • Multi-Specialty Clinic/Center
  • Fenton, MO
  • NPI 1700966207
  Medicare reassignment Care Compare group NPD
• Physicians Ambulatory Surgery Center LLC

  • Ambulatory Surgical Clinic/Center
  • Saint Peters, MO
  • NPI 1285358481

  Pain Medicine

  NPD Authorized official
• Pro Pain LLC

  • Pain Medicine (Anesthesiology) Physician
  • Saint Peters, MO
  • NPI 1649735879
  Authorized official Same address or phone
• Professional Physicians Pain Services, LLC

  dba Professional Pain Physicians

  • Pain Medicine (Anesthesiology) Physician
  • Saint Peters, MO
  • NPI 1295062016
  Authorized official Same address or phone
• Pro Pain LLC

  • Interventional Pain Medicine Physician
  • Saint Peters, MO
  • NPI 1235965401
  NPD
• SSM Medical Group Inc.

  dba SSM Health Medical Group

  • Durable Medical Equipment & Medical Supplies
  • Warrenton, MO
  • NPI 1467997155
  NPD
• SSM St Clare Surgical Center LLC

  • Ambulatory Surgical Clinic/Center
  • Fenton, MO
  • NPI 1033351119
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Barnes Jewish St Peters Hospital Inc

  dba Barnes-Jewish St Peters Hospital

  • General Acute Care Hospital
  • Saint Peters, MO
  • NPI 1144238908
  Care Compare affiliation
• Mercy Hospitals East Communities

  dba Mercy Hospital St Louis

  • General Acute Care Hospital
  • Saint Louis, MO
  • NPI 1427098169
  Care Compare affiliation
• Mercy Hospitals East Communities

  dba Mercy St. Louis Transport Ambulance

  • Land Ambulance
  • Saint Louis, MO
  • NPI 1881329902

  Hospital

  Care Compare affiliation
• SSM Health Care St. Louis

  dba SSM Health St. Joseph Hospital - St. Charles

  • General Acute Care Hospital
  • Saint Charles, MO
  • NPI 1467521146
  Care Compare affiliation
• SSM Health Care St. Louis

  dba SSM Health St. Clare Hospital - Fenton

  • General Acute Care Hospital
  • Fenton, MO
  • NPI 1851496152
  Care Compare affiliation
• SSM Select Rehab St Louis LLC

  • Rehabilitation Hospital
  • Richmond Heights, MO
  • NPI 1659511988

  Inpatient rehabilitation facility

  Care Compare affiliation
• St. Lukes Episcopal-Presbyterian Hospital

  dba St. Luke's Hospital

  • General Acute Care Hospital
  • Chesterfield, MO
  • NPI 1346251543
  Care Compare affiliation

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

{
    "created_epoch": "1137024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603152000000",
    "number": "1043299548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 MEXICO RD STE 101",
            "city": "SAINT PETERS",
            "state": "MO",
            "postal_code": "633761666",
            "telephone_number": "636-442-5035",
            "fax_number": "636-442-5036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 BOWLES AVE STE 202",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630262308",
            "telephone_number": "636-386-7222",
            "fax_number": "636-386-7810"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4800 Mexico Rd Ste 101",
            "address_purpose": "LOCATION",
            "city": "Saint Peters",
            "state": "MO",
            "postal_code": "633761666",
            "country_code": "US",
            "telephone_number": "636-442-5035",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOEDEFELD",
        "first_name": "MICHAEL",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-12",
        "last_updated": "2020-10-20",
        "certification_date": "2020-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MO",
            "license": "2004009978",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "MO",
            "license": "2004009978",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "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": "1055 Bowles Ave Ste 202",
            "city": "Fenton",
            "state": "MO",
            "country_code": "US",
            "postal_code": "630262308",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mboedefeld17681@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "mboedefeld17681@direct-ehr-ssmhc.com",
            "address_1": "1055 Bowles Ave Ste 202",
            "city": "Fenton",
            "state": "MO",
            "country_code": "US",
            "postal_code": "630262308",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Joseph A. Blaes, DDS
• Danielle Rebecca Blake
• April Louise Blandford, DPT
• Diane Denise Block, NP
• Kellie L Blow, DPT
• Emily Bohnert
• Bon Vivant Adult Day Club L.L.C.
• Susan Elizabeth Bonk, MS, CCC-SLP
• Nicole M Book, MS, LPC
• Melanie Marie Boon, APN

• Pain Medicine (Anesthesiology) Physician in Fenton, MO
• Providers in Fenton, MO by specialty
• Pain Medicine (Anesthesiology) Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.