Active NPI
Matthew J Spellman, MD
- Urology Physician
- Saint Louis, MO
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- 2002031745
- Practice address
- 12855 N 40 Dr
Suite 375
Saint Louis, MO 63141-8635 - Phone
- (314) 567-6071
- Fax
- (314) 567-7961
- NPI assigned
- Nov 30, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician | 208800000X | 2002031745 | MO | Primary |
| Urology Physician | 208800000X | 036-108257 | IL |
Addresses
Primary practice location
12855 N 40 Dr
Suite 375
Saint Louis, MO 63141-8635
Mailing address
12855 N 40 Dr
Suite 375
Saint Louis, MO 63141-8635
Phone (314) 567-6071
Other practice location 1
450 N New Ballas Rd Ste 150
Saint Louis, MO 63141-6835
Phone (314) 315-9914
Other practice location 2
3844 S Lindbergh Blvd Ste 125
Saint Louis, MO 63127-1416
Phone (314) 567-6075
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036108257 | Medicaid | IL | |
| 209087709 | Medicaid | MO |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| FHIR URL | https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2 | Health Information Exchange (HIE) | Missouri Baptist Medical Center |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO, IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Urology
- Education
- University of Iowa, RJ & L Carver College of Medicine, 1997
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
12855 N 40 Dr
Suite 375
Saint Louis, MO 63141-8657
Phone (314) 567-6071
6812 State Route 162 200
Maryville, IL 62062-8562
Phone (618) 288-0900
Hospital & facility affiliations
- Missouri Baptist Medical Center
- St Lukes Hospital
- Alton Memorial Hospital
- HSHS St Elizabeth'S Hospital
- Barnes Jewish Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Prostate resection | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-108257 | IL | MD | Urology Physician |
| 2002031745 | MO | MD | Urology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Osf Multi-Specialty Group | Current | Accepting new patients | |
| Central PA Pharmacy LLC. | Current | Accepting new patients | |
| Ahs Il Medical Group LLC | Current | Accepting new patients | |
| Urology of St. Louis, Inc. | Current | Accepting new patients | |
| Urology of St. Louis, Inc. | Urology | Current | Accepting new patients |
| Urology of St. Louis, Inc. | Urology | Past | Accepting new patients |
Locations
2 Saint Anthonys Way
Ste 205
Alton, IL 62002
Phone (618) 462-2222
1 Saint Anthonys Way
Alton, IL 62002
Phone (618) 233-6870
2044 Madison Ave
Ste G7
Granite City, IL 62040
Phone (314) 500-2424
6812 State Route 162
Ste 200
Maryville, IL 62062
Phone (618) 288-0900
8 Doctors Park Rd
Mount Vernon, IL 62864
Phone (618) 244-5500
8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050
215 Dunn Rd
Florissant, MO 63031
Phone (314) 315-9911
12855 N 40 Dr
Ste 375
Saint Louis, MO 63141
3844 S Lindbergh Blvd
Ste 125
Saint Louis, MO 63127
Phone (314) 733-9009
12855 N 40 Dr
Ste Ll
Saint Louis, MO 63141
456 N New Ballas Rd
Ste 348
Saint Louis, MO 63141
Phone (314) 548-0265
12855 N 40 Dr
Saint Louis, MO 63141
Phone (314) 432-4415
12855 N 40 Dr
Ste 350
Saint Louis, MO 63141
Phone (314) 205-1926
Interoperability endpoints
- matthewspellman@slus.allscriptsdirect.net
- mspellma@yourcarecommunity.org
Organizations & group practices 6
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.
-
- Clinic/Center
- Granite City, IL
- NPI 1659098101
-
- Internal Medicine Physician
- Peoria, IL
- NPI 1922445527
-
- Community/Retail Pharmacy
- Patton, PA
- NPI 1578541413
-
- Specialist
- O Fallon, IL
- NPI 1265392476
-
- Urology Physician
- Fairview Heights, IL
- NPI 1528901287
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Saint Louis, MO
- NPI 1649299827
-
- General Acute Care Hospital
- Saint Louis, MO
- NPI 1487663506
-
- General Acute Care Hospital
- Chesterfield, MO
- NPI 1346251543
-
- General Acute Care Hospital
- Alton, IL
- NPI 1548278476
-
- General Acute Care Hospital
- O Fallon, IL
- NPI 1629057302
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133308800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1638316800000",
"number": "1205810520",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12855 N 40 DR",
"address_2": "SUITE 375",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631418635",
"telephone_number": "314-567-6071",
"fax_number": "314-567-7961"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12855 N 40 DR",
"address_2": "SUITE 375",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631418635",
"telephone_number": "314-567-6071",
"fax_number": "314-567-7961"
}
],
"practiceLocations": [
{
"address_1": "450 N New Ballas Rd Ste 150",
"address_purpose": "LOCATION",
"city": "Saint Louis",
"state": "MO",
"postal_code": "631416835",
"country_code": "US",
"telephone_number": "314-315-9914",
"fax_number": "314-315-9970",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3844 S Lindbergh Blvd Ste 125",
"address_purpose": "LOCATION",
"city": "Saint Louis",
"state": "MO",
"postal_code": "631271416",
"country_code": "US",
"telephone_number": "314-567-6075",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SPELLMAN",
"first_name": "MATTHEW",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-30",
"last_updated": "2021-12-01",
"certification_date": "2021-12-01",
"status": "A"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "MO",
"license": "2002031745",
"primary": true
},
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "IL",
"license": "036-108257",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036108257",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "209087709",
"state": "MO"
}
],
"endpoints": [
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2",
"affiliation": "Y",
"endpointDescription": "bjc",
"affiliationName": "Missouri Baptist Medical Center",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "12855 N 40 Dr",
"address_2": "Suite 375",
"city": "Saint Louis",
"state": "MO",
"country_code": "US",
"postal_code": "631418635",
"country_name": "United States",
"address_type": "DOM"
}
],
"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 Dec 1, 2021; 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.