Individual provider Active NPI

Clayton Greer Scanlon, MD

  • Retina Specialist (Ophthalmology) Physician
  • Florissant, MO
National Provider Identifier
1073778460
Registry record updated Sep 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Retina Specialist (Ophthalmology) PhysicianTaxonomy code 207WX0107X
License
2014015320 Issued in MO
Practice address
1224 Graham Rd
3011
Florissant, MO 63031-8028
Phone
(314) 839-1211
Fax
(314) 893-8429
NPI assigned
Jul 24, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 28, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Retina Specialist (Ophthalmology) Physician 207WX0107X 2014015320 MO Primary

Addresses

Primary practice location

1224 Graham Rd
3011
Florissant, MO 63031-8028

Mailing address

1224 Graham Rd
3011
Florissant, MO 63031-8028
Phone (314) 839-1211

Other identifiers 3

IdentifierTypeStateIssuer
1529171MedicaidTN
09488897MedicaidMS
194545001MedicaidAR

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20141013001397 MO Practitioner - Ophthalmology 1850557547 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Retina Associates of St Louis, IncGroup PAC ID 3577522101, 4 clinicians

Practice addresses (Care Compare)

1224 Graham Rd
Suite 3011
Florissant, MO 63031-8028
Phone (314) 839-1211

12990 Manchester Rd
Suite 104
Des Peres, MO 63131-1860
Phone (314) 872-8884

5700 Mexico Rd
Suite 4
Saint Peters, MO 63376-1667
Phone (636) 926-3700

6680 Chippewa
Suite 220
St Louis, MO 63109-2537

6680 Chippewa St
Suite 220
Saint Louis, MO 63109-2537
Phone (314) 351-0101

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
97.79
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
92.04 of 100Reported as group
Quality
100
Improvement activities
40
Cost
73.47

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2014015320MOMDRetina Specialist (Ophthalmology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Retina Associates of St Louis, Inc Retina Specialist CurrentSince Aug 11, 2014 Accepting new patients
Retina Contracting Inc Past Accepting new patients

Locations

1224 Graham Rd
Ste 3011
Florissant, MO 63031
Phone (314) 839-1211

12990 Manchester Rd
Ste 104
Saint Louis, MO 63131
Phone (314) 872-8884

5700 Mexico Rd
Ste 4
Saint Peters, MO 63376
Phone (636) 926-3700

1701 Heritage Hills Dr
Washington, MO 63090
Phone (636) 229-1265

Organizations & group practices 3

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1216857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664323200000",
    "number": "1073778460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1224 GRAHAM RD",
            "address_2": "3011",
            "city": "FLORISSANT",
            "state": "MO",
            "postal_code": "630318028",
            "telephone_number": "314-839-1211",
            "fax_number": "314-893-8429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1224 GRAHAM RD",
            "address_2": "3011",
            "city": "FLORISSANT",
            "state": "MO",
            "postal_code": "630318028",
            "telephone_number": "314-839-1211",
            "fax_number": "314-893-8429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCANLON",
        "first_name": "CLAYTON",
        "middle_name": "GREER",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-07-24",
        "last_updated": "2022-09-28",
        "certification_date": "2022-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207WX0107X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Retina Specialist",
            "state": "MO",
            "license": "2014015320",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1529171",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09488897",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "194545001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Florissant, MO

Sources for this page

Verify at the official NPI Registry.