Individual provider Active NPI

Marissa Morningstar Tenenbaum, MD

  • Plastic and Reconstructive Surgery Physician
  • Saint Louis, MO
National Provider Identifier
1124232236
Registry record updated Apr 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
License
2008029868 Issued in MO
Practice address
4921 Parkview PL
Div Surg Plastics, Ste 6G
Saint Louis, MO 63110-1032
Phone
(314) 362-7388
Fax
(833) 301-0853
NPI assigned
May 9, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic and Reconstructive Surgery Physician 2086S0122X 2008029868 MO Primary

Addresses

Primary practice location

4921 Parkview PL
Div Surg Plastics, Ste 6G
Saint Louis, MO 63110-1032

Mailing address

PO Box 7412011
Chicago, IL 60674-2011
Phone (314) 362-7388

Other identifiers 1

IdentifierTypeStateIssuer
201009008MedicaidMO

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Washington University

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
I20081210000510 MO Practitioner - Plastic and Reconstructive Surgery 6608937560 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Plastic and Reconstructive Surgery
Education
University of Wisconsin School of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Washington UniversityGroup PAC ID 9830008770, 2,968 clinicians

Practice addresses (Care Compare)

4921 Parkview PL
Suite G6TH
Saint Louis, MO 63110-1032
Phone (314) 362-7388

Hospital & facility affiliations

  • Barnes-Jewish West County Hospital Hospital, Creve Coeur, MO, CCN 260162
  • Missouri Baptist Medical Center Hospital, Saint Louis, MO, CCN 260108
  • Barnes Jewish Hospital Hospital, Saint Louis, MO, CCN 260032

Merit-based Incentive Payment System (MIPS)

Final score
84.2 of 100Reported as group
Quality
71.6
Promoting interoperability
100
Improvement activities
40
Cost
75.75

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy16
Melanoma (skin cancer) excision1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2008029868MOMDPlastic and Reconstructive Surgery Physician

Interoperability endpoints

  • Direct secure messaging: mtenenbaum154591@direct.carenet.org

Organizations & group practices 1

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 3

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": "1178668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745193600000",
    "number": "1124232236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7412011",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606742011",
            "telephone_number": "314-362-7388",
            "fax_number": "833-301-0853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4921 PARKVIEW PL",
            "address_2": "DIV SURG PLASTICS, STE 6G",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101032",
            "telephone_number": "314-362-7388",
            "fax_number": "833-301-0853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TENENBAUM",
        "first_name": "MARISSA MORNINGSTAR",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-09",
        "last_updated": "2025-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "MO",
            "license": "2008029868",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201009008",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "4921 Parkview Pl",
            "address_2": "Div Surg Plastics, Ste 6G",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631101032",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.