Active NPI
Micheal Haydon Shrum, PA
- Physician Assistant
- Saint Louis, MO
National Provider Identifier
1417546193
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 2022033888
- Practice address
- 615 S New Ballas Rd
Saint Louis, MO 63141-8221 - Phone
- (314) 251-6339
- NPI assigned
- Jan 15, 2021
- Last updated
- Sep 8, 2022
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 2022033888 | MO | Primary |
Addresses
Primary practice location
615 S New Ballas Rd
Saint Louis, MO 63141-8221
Mailing address
705 Wild Horse Creek Dr
Fairview Heights, IL 62208-2047
Phone (618) 954-3043
Other practice location 1
3437 Caroline St # 3082
Saint Louis, MO 63104-1111
Phone (314) 977-8644
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care CompareMerit-based Incentive Payment System (MIPS)
- Final score
- 0 of 100
- Quality
- 0
- Promoting interoperability
- 0
- Improvement activities
- 0
- Cost
- 0
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1610668800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1662595200000",
"number": "1417546193",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "705 WILD HORSE CREEK DR",
"city": "FAIRVIEW HEIGHTS",
"state": "IL",
"postal_code": "622082047",
"telephone_number": "618-954-3043"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "615 S NEW BALLAS RD",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631418221",
"telephone_number": "314-251-6339"
}
],
"practiceLocations": [
{
"address_1": "3437 Caroline St # 3082",
"address_purpose": "LOCATION",
"city": "Saint Louis",
"state": "MO",
"postal_code": "631041111",
"country_code": "US",
"telephone_number": "314-977-8644",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SHRUM",
"first_name": "MICHEAL",
"middle_name": "HAYDON",
"name_prefix": "Mr.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-01-15",
"last_updated": "2022-09-08",
"certification_date": "2022-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MO",
"license": "2022033888",
"primary": true
}
],
"identifiers": [],
"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 Sep 8, 2022; 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.