Individual provider Active NPI

Daniel Charles Mulawa, PA-C

  • Medical Physician Assistant
  • Ballwin, MO
National Provider Identifier
1205517505
Registry record updated Oct 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
2025037004 Issued in MO
Practice address
15945 Clayton Rd Ste 330
Ballwin, MO 63011-2492
Phone
(636) 256-5380
Fax
(636) 256-5396
NPI assigned
Jul 28, 2023
Last updated
Oct 22, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 2025037004 MO Primary

Addresses

Primary practice location

15945 Clayton Rd Ste 330
Ballwin, MO 63011-2492

Mailing address

15945 Clayton Rd Ste 330
Ballwin, MO 63011-2492
Phone (636) 256-5380

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251121001665 MO Practitioner - Physician Assistant 1658728498 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mercy Clinic East CommunitiesGroup PAC ID 7214827922, shared by 6 NPIs, 573 clinicians
Indiana Health Centers IncGroup PAC ID 3971599473, shared by 16 NPIs, 63 clinicians

Practice addresses (Care Compare)

15945 Clayton Rd
Ballwin, MO 63011-2490
Phone (636) 256-5070

1700 Dividend Dr
Logansport, IN 46947-1572
Phone (574) 722-7407

621 S New Ballas Rd
Suite 4017B
Saint Louis, MO 63141-8269
Phone (314) 872-9192

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2025037004MOMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic East Communities Current Accepting new patients
Mercy Clinic East Communities CurrentSince Oct 13, 2025 Accepting new patients
Indiana Health Centers, Inc. Past Accepting new patients

Locations

15945 Clayton Rd
Ste 320
Ballwin, MO 63011
Phone (636) 256-5350

15945 Clayton Rd
Ste 330
Ballwin, MO 63011
Phone (636) 256-5380

621 S New Ballas Rd
Ste 4017B
Saint Louis, MO 63141
Phone (314) 872-9192

851 E 5th St
Ste 328
Washington, MO 63090
Phone (636) 239-1101

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 5

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": "1690502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761091200000",
    "number": "1205517505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15945 CLAYTON RD STE 330",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630112492",
            "telephone_number": "636-256-5380",
            "fax_number": "636-256-5396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15945 CLAYTON RD STE 330",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630112492",
            "telephone_number": "636-256-5380",
            "fax_number": "636-256-5396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULAWA",
        "first_name": "DANIEL",
        "middle_name": "CHARLES",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-07-28",
        "last_updated": "2025-10-22",
        "certification_date": "2025-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MO",
            "license": "2025037004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ballwin, MO

Sources for this page

Verify at the official NPI Registry.