Individual provider Active NPI

Russell A Sztukowski, PA

  • Physician Assistant
  • Saint Louis, MO
National Provider Identifier
1477194447
Registry record updated Jul 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2022034174 Issued in MO
Practice address
621 S New Ballas Rd Ste 560a
Saint Louis, MO 63141-8261
Phone
(314) 251-6440
NPI assigned
Oct 1, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2022034174 MO Primary

Addresses

Primary practice location

621 S New Ballas Rd Ste 560a
Saint Louis, MO 63141-8261

Mailing address

621 S New Ballas Rd Ste 560a
Saint Louis, MO 63141-8261
Phone (314) 251-6440

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221017001006 MO Practitioner - Physician Assistant 0345675765 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Southern Illinois University School of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy East Ambulatory Services LLCGroup PAC ID 2365739240, 102 clinicians

Practice addresses (Care Compare)

2031 Zumbehl Rd
Saint Charles, MO 63303-2723
Phone (636) 206-2690

2991 Hwy K
O Fallon, MO 63368-7862
Phone (636) 435-2333

409 Lafayette Ctr
Manchester, MO 63011-3943
Phone (636) 707-0764

6167 Mid Rivers Mall Dr
Saint Peters, MO 63304-1105
Phone (636) 364-4990

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2022034174MOMDPhysician Assistant

Organizations & group practices 3

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": "1569888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721692800000",
    "number": "1477194447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 S NEW BALLAS RD STE 560A",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418261",
            "telephone_number": "314-251-6440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 S NEW BALLAS RD STE 560A",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418261",
            "telephone_number": "314-251-6440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SZTUKOWSKI",
        "first_name": "RUSSELL",
        "middle_name": "A",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-10-01",
        "last_updated": "2024-07-23",
        "certification_date": "2024-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2022034174",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.