Paul De Vries Rains, D.O.
Individual provider Active NPI Family Medicine Physician · Ellington, MO
NPI 1437152303 · NPPES record last updated Oct 3, 2011
Key facts
- NPI
- 1437152303
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- R3M48 (MO)
- Practice address
- 350 E Walnut St
Ellington, MO 63638-7943 - Phone
- (573) 663-2571
- Fax
- (573) 663-2779
- NPI assigned
- May 24, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040924000684 | MO | Practitioner - Family Practice |
1153310172 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R3M48 | MO | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fast Track Medical LLC | Current |
Accepting new patients | |
| Fast Track Medical LLC | Current |
Accepting new patients | |
| Fast Track Urgent Care LLC | Current | Accepting new patients | |
| Ozarks Medical Center | Family Medicine | Past | Accepting new patients |
| Advanced Health Care Management Services, LLC | Past |
Accepting new patients |
Locations
2686 N Highway 67
Florissant, MO 63033
Phone (314) 436-9300
5701 Chippewa St
Saint Louis, MO 63109
Phone (314) 921-7300
9845 West Florissant Ave
Saint Louis, MO 63136
Phone (314) 736-6100
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | R3M48 | MO | Yes |
Addresses
Primary practice location
350 E Walnut St
Ellington, MO 63638-7943
Mailing address
350 E Walnut St
Ellington, MO 63638-7943
Phone (573) 663-2571
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 597719509 | Medicaid | MO |
Other providers in Ellington, MO
- Medley Pharmacy Inc.
- Meramec Emergency Physicians, LLP
- Rachel E Morris
- Shawna Renee Myers
- Shelby Nicole Ohrenberg
- Iris Fae Ross
- Rodney T. Rubi
- Jenny S. Russell
- Rebecca Rae Singleton
- Southeast Health Center of Reynolds County LLC
All providers in Ellington, MO · Family Medicine Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 3, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.