NPIMap

Individual provider Active NPI

Michael Harry Mastromichalis, M.D.

  • Urology Physician
  • Fenton, MO
National Provider Identifier
1346444700
Registry record updated Nov 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
2008016598 Issued in MO
Practice address
1011 Bowles Ave Ste 425
Fenton, MO 63026-2384
Phone
(636) 496-5030
Fax
(636) 496-5025
NPI assigned
Jun 12, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 2008016598 MO Primary

Addresses

Primary practice location

1011 Bowles Ave Ste 425
Fenton, MO 63026-2384

Mailing address

PO Box 955534
Saint Louis, MO 63195-5534

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address mmastromichalis18979@direct-ehr-ssmhc.com Direct
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230712001232 WV Practitioner - Urology 4284789330 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
West Virginia University School of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
THS Physician Partners IncGroup PAC ID 9537316393, 366 clinicians

Practice addresses (Care Compare)

4607 Maccorkle Ave SW
Suite 206
South Charleston, WV 25309-1364
Phone (304) 766-1133

Hospital & facility affiliations

  • Thomas Memorial Hospital Hospital, South Charleston, WV, CCN 510029
  • Charleston Area Medical Center Hospital, Charleston, WV, CCN 510022
  • Braxton County Memorial Hospital, Inc Hospital, Gassaway, WV, CCN 511308
  • Jackson General Hospital Hospital, Ripley, WV, CCN 511320

Merit-based Incentive Payment System (MIPS)

Final score
95.34 of 100Reported as apm
Quality
79.86
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2008016598MOMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
THS Physician Partners Inc Urology CurrentSince Jul 10, 2023 Accepting new patients

Locations

L3539
Columbus, OH 43260
Phone (304) 414-4800

4607 Maccorkle Ave SW
Ste 206
South Charleston, WV 25309
Phone (304) 766-1133

4605 Maccorkle Ave SW
South Charleston, WV 25309
Phone (304) 414-4800

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.

Hospital & facility affiliations 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1181606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604534400000",
    "number": "1346444700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 955534",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631955534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 BOWLES AVE STE 425",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630262384",
            "telephone_number": "636-496-5030",
            "fax_number": "636-496-5025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MASTROMICHALIS",
        "first_name": "MICHAEL",
        "middle_name": "HARRY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-12",
        "last_updated": "2020-11-05",
        "certification_date": "2020-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "MO",
            "license": "2008016598",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mmastromichalis18979@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "mmastromichalis18979@direct-ehr-ssmhc.com",
            "address_1": "1011 Bowles Ave Ste 425",
            "city": "Fenton",
            "state": "MO",
            "country_code": "US",
            "postal_code": "630262384",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "1011 Bowles Ave Ste 425",
            "city": "Fenton",
            "state": "MO",
            "country_code": "US",
            "postal_code": "630262384",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fenton, MO

Sources for this page

Verify at the official NPI Registry.