Active NPI
Michael Fedak, M.D.
- Internal Medicine Physician
- Saint Louis, MO
National Provider Identifier
1174514384
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 36371
- Practice address
- 13303 Tesson Ferry Rd
Suite 150
Saint Louis, MO 63128-4062 - Phone
- (314) 842-4744
- Fax
- (314) 842-3835
- NPI assigned
- Nov 4, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 36371 | MO | Primary |
Addresses
Primary practice location
13303 Tesson Ferry Rd
Suite 150
Saint Louis, MO 63128-4062
Mailing address
PO Box 419052
Saint Louis, MO 63141-9052
Phone (314) 851-1000
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100609 | Other | MO | HEALTHLINK |
| 25552 | Other | MO | BCBS |
| 127478 | Other | MO | GHP |
| 0400399 | Other | MO | UHC |
| 000000010015 | Other | MO | ESSENCE |
| A29062 | Other | MO | MERCY |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Internal Medicine
- Education
- University of Missouri, Columbia School of Medicine, 1982
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
13303 Tesson Ferry Rd
Suite 150
Saint Louis, MO 63128-4066
Phone (314) 842-5239
Hospital & facility affiliations
- Amedisys Home Health of Missouri
- Mercy Hospital South
- Mercy Hospital St Louis
- Missouri Baptist Medical Center
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Interoperability endpoints
- michael.fedak.p1@direct.essehealth.nextgenshare.com
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.
-
- Internal Medicine Physician
- Saint Louis, MO
- NPI 1972559532
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Home Health Agency
- Hillsboro, MO
- NPI 1164433041
-
- General Acute Care Hospital
- Saint Louis, MO
- NPI 1568481984
-
- General Acute Care Hospital
- Saint Louis, MO
- NPI 1427098169
-
- General Acute Care Hospital
- Saint Louis, MO
- NPI 1487663506
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131062400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1736121600000",
"number": "1174514384",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 419052",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631419052",
"telephone_number": "314-851-1000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13303 TESSON FERRY RD",
"address_2": "SUITE 150",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631284062",
"telephone_number": "314-842-4744",
"fax_number": "314-842-3835"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FEDAK",
"first_name": "MICHAEL",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-04",
"last_updated": "2025-01-06",
"certification_date": "2025-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MO",
"license": "36371",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHLINK",
"identifier": "100609",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "25552",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHP",
"identifier": "127478",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UHC",
"identifier": "0400399",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ESSENCE",
"identifier": "000000010015",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MERCY",
"identifier": "A29062",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2025; 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.