Individual provider Active NPI

Luke Philip Landolt, DO

  • Anesthesiology Physician
  • Saint Louis, MO
National Provider Identifier
1205395308
Registry record updated Nov 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
2024015928 Issued in MO
Practice address
615 S New Ballas Rd
Saint Louis, MO 63141-8221
Phone
(636) 386-9224
Fax
(636) 386-7679
NPI assigned
Mar 18, 2019
Last updated
Nov 25, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X OS19992 FL
Anesthesiology Physician 207L00000X 2024015928 MO Primary

Addresses

Primary practice location

615 S New Ballas Rd
Saint Louis, MO 63141-8221

Mailing address

339 Consort Dr
Ballwin, MO 63011-4439
Phone (636) 386-9224

Other identifiers 2

IdentifierTypeStateIssuer
200071922MedicaidMO
118400900MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, MO2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20230724000597 FL Practitioner - Anesthesiology 1658606405 Reassigns benefits to 1 organization
I20241008002151 MO Practitioner - Anesthesiology 1658606405 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Western Anesthesiology Associates IncGroup PAC ID 6204720667, 251 clinicians

Practice addresses (Care Compare)

615 S New Ballas Rd
Saint Louis, MO 63141-8221
Phone (314) 251-4687

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
47.54 of 100Reported as apm
Quality
38.49
Promoting interoperability
0
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Clinical Practice Association Inc CurrentSince Jul 1, 2023 Accepting new patients
Western Anesthesiology Associates, Inc. Anesthesiology CurrentSince Sep 10, 2024 Accepting new patients
Florida Clinical Practice Association Inc CurrentSince Jul 1, 2023 Accepting new patients

Locations

1600 SW Archer Rd
Gainesville, FL 32610
Phone (352) 265-0077

2001 SW 13th St
Gainesville, FL 32608
Phone (352) 265-8990

339 Consort Dr
Ballwin, MO 63011
Phone (636) 386-7222

615 S New Ballas Rd
Saint Louis, MO 63141
Phone (314) 251-4687

901 E 5th St
Washington, MO 63090
Phone (636) 239-8000

901 Patients First Dr
Ste 108
Washington, MO 63090
Phone (636) 390-1715

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1552867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732492800000",
    "number": "1205395308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "339 CONSORT DR",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630114439",
            "telephone_number": "636-386-9224",
            "fax_number": "636-386-7679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 S NEW BALLAS RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418221",
            "telephone_number": "636-386-9224",
            "fax_number": "636-386-7679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANDOLT",
        "first_name": "LUKE",
        "middle_name": "PHILIP",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-18",
        "last_updated": "2024-11-25",
        "certification_date": "2024-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "FL",
            "license": "OS19992",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MO",
            "license": "2024015928",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200071922",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "118400900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.