NPIMap

Individual provider Active NPI

Marvina Moore Amerson, DO

  • Anesthesiology Physician
  • Saint Louis, MO
National Provider Identifier
1205877800
Registry record updated Jul 28, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
200601640 Issued in MO
Practice address
3015 N Ballas Rd
Anesthesiology Department - 2ND FL
Saint Louis, MO 63131-2329
Phone
(314) 996-5330
NPI assigned
Jun 8, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2010

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 02756 KY
Anesthesiology Physician 207L00000X 200601640 MO Primary
Anesthesiology Physician 207L00000X 033561 GA
Anesthesiology Physician 207L00000X 2856 OK
Anesthesiology Physician 207L00000X 13461 MS

Addresses

Primary practice location

3015 N Ballas Rd
Anesthesiology Department - 2ND FL
Saint Louis, MO 63131-2329

Mailing address

3015 N Ballas Rd
Anesthesiology Department - 2ND FL
Saint Louis, MO 63131-2329
Phone (314) 996-5330

Other identifiers 1

IdentifierTypeStateIssuer
1205877800MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
033561GAMDAnesthesiology Physician
02756KYMDAnesthesiology Physician
200601640MOMDAnesthesiology Physician
13461MSMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Broad Anesthesia Associates Anesthesiology Past Accepting new patients
Capitol Anesthesiology, PC Anesthesiology Past Accepting new patients
Amsol Physicians of Columbus Ga LLC Anesthesiology Past Accepting new patients
Broad Midwest Anesthesia, LLC Anesthesiology Past Accepting new patients
Jackson Hospital Corporation Anesthesiology Past Accepting new patients
Ctca Physicans Group of Oklahoma, Inc Past Accepting new patients

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280275200000",
    "number": "1205877800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3015 N BALLAS RD",
            "address_2": "ANESTHESIOLOGY DEPARTMENT - 2ND FL",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631312329",
            "telephone_number": "314-996-5330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3015 N BALLAS RD",
            "address_2": "ANESTHESIOLOGY DEPARTMENT - 2ND FL",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631312329",
            "telephone_number": "314-996-5330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE AMERSON",
        "first_name": "MARVINA",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-08",
        "last_updated": "2010-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "KY",
            "license": "02756",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MO",
            "license": "200601640",
            "primary": true
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "GA",
            "license": "033561",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "OK",
            "license": "2856",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MS",
            "license": "13461",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1205877800",
            "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 Jul 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.