Individual provider Active NPI

Kevin R Mahoney, MD

  • Trauma Surgery Physician
  • Saint Louis, MO
National Provider Identifier
1386745115
Registry record updated Sep 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Trauma Surgery PhysicianTaxonomy code 2086S0127X
License
2007020558 Issued in MO
Practice address
1225 S Grand Blvd
Level 2
Saint Louis, MO 63104-1016
Phone
(314) 977-4440
Fax
(314) 977-1877
NPI assigned
Sep 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Trauma Surgery Physician 2086S0127X 2007020558 MO Primary
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 43940 WI
Surgery Physician 208600000X 43940 WI

Addresses

Primary practice location

1225 S Grand Blvd
Level 2
Saint Louis, MO 63104-1016

Mailing address

1008 S Spring Ave Ste 1615
Saint Louis, MO 63110-2520
Phone (314) 977-4717

Other practice location 1

915 N Grand Ave
Saint Louis, MO 63106
Phone (314) 652-4100

Other identifiers 2

IdentifierTypeStateIssuer
34148300MedicaidWI
208544213MedicaidMO

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address kmahoney14910@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 MO
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 1

Enrollment IDStateProvider typePAC IDDetails
I20071023000173 MO Practitioner - General SurgeryPractitioner - Critical Care (Intensivists) 2466548466 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General SurgeryAlso: Critical Care (Intensivists)
Education
University of Minnesota Medical School, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SSM Health Care GroupGroup PAC ID 0143608372, 929 clinicians

Practice addresses (Care Compare)

10101 Woodfield LN
Saint Louis, MO 63132-2946
Phone (608) 280-4647

1201 S Grand Blvd
Saint Louis, MO 63104-1016
Phone (314) 617-2000

1225 S Grand Blvd
Saint Louis, MO 63104-1016

Hospital & facility affiliations

  • SSM Health Saint Louis University Hospital Hospital, Saint Louis, MO, CCN 260105

Merit-based Incentive Payment System (MIPS)

Final score
84.94 of 100Reported as group
Quality
68.52
Promoting interoperability
100
Improvement activities
40
Cost
72.22

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
43940WIMDCritical Care Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
SSM Cardinal Glennon Childrens Hospital CurrentSince Jun 25, 2020 Accepting new patients
SSM Health Care Group CurrentSince Jul 1, 2022 Accepting new patients
SSM Health Care Group Surgery CurrentSince Jul 1, 2022 Accepting new patients
SSM Cardinal Glennon Children'S Hospital CurrentSince Jun 25, 2020 Accepting new patients
SSM Medical Group Inc. PastSince Feb 14, 2021 Accepting new patients

Locations

7344 Solutions Ctr
Chicago, IL 60677
Phone (314) 989-6189

1225 S Grand Blvd
#2
Saint Louis, MO 63104
Phone (314) 977-4700

1465 S Grand Blvd
Saint Louis, MO 63104
Phone (314) 268-4070

1201 S Grand Blvd
Saint Louis, MO 63104
Phone (314) 257-8222

3635 Vista Ave
Saint Louis, MO 63110
Phone (314) 577-8022

10101 Woodfield Ln
Saint Louis, MO 63132
Phone (608) 280-4647

Interoperability endpoints

  • Direct secure messaging: kmahoney14910@direct-ehr-ssmhc.com

Organizations & group practices 5

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 1

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": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758499200000",
    "number": "1386745115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1008 S SPRING AVE STE 1615",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631102520",
            "telephone_number": "314-977-4717",
            "fax_number": "314-977-1877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 S GRAND BLVD",
            "address_2": "LEVEL 2",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631041016",
            "telephone_number": "314-977-4440",
            "fax_number": "314-977-1877"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "915 N Grand Ave",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "63106",
            "country_code": "US",
            "telephone_number": "314-652-4100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAHONEY",
        "first_name": "KEVIN",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-26",
        "last_updated": "2025-09-22",
        "certification_date": "2025-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0127X",
            "taxonomy_group": "",
            "desc": "Surgery, Trauma Surgery",
            "state": "MO",
            "license": "2007020558",
            "primary": true
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "WI",
            "license": "43940",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WI",
            "license": "43940",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34148300",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208544213",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kmahoney14910@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "kmahoney14910@direct-ehr-ssmhc.com",
            "address_1": "1201 S Grand Blvd",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631041016",
            "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": "1201 S Grand Blvd",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631041016",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.