Individual provider Active NPI

Melody Santos, M.D.

  • Pediatrics Physician
  • Swansea, IL
National Provider Identifier
1487672903
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Practice address
3 Park PL
Swansea, IL 62226-2965
Phone
(618) 222-9244
Fax
(618) 222-9248
NPI assigned
Jul 17, 2006
Last updated
Jul 9, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 2000146144 MO
Pediatrics Physician 208000000X IL Primary

Addresses

Primary practice location

3 Park PL
Swansea, IL 62226-2965

Mailing address

7980 Clayton Rd
Suite 202
Saint Louis, MO 63117-1354
Phone (314) 951-5368

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171024001128 IL Practitioner - Pediatric Medicine 5890061626 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-100672ILMDPediatrics Physician
2000146144MOMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
SSM Medical Group Inc. CurrentSince Aug 30, 2017 Accepting new patients
SSM Medical Group, Inc. CurrentSince Aug 30, 2017 Accepting new patients
SSM Health Care St. Louis Pediatrics Past Accepting new patients
SSM Depaul Medical Group, Inc. Pediatrics Past Accepting new patients

Locations

705 S Grand St
Nashville, IL 62263
Phone (618) 327-2200

1551 Wall St
Ste 310
Saint Charles, MO 63303
Phone (636) 669-2268

Organizations & group practices 4

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": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1487672903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7980 CLAYTON RD",
            "address_2": "SUITE 202",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631171354",
            "telephone_number": "314-951-5368",
            "fax_number": "314-951-5238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 PARK PL",
            "city": "SWANSEA",
            "state": "IL",
            "postal_code": "622262965",
            "telephone_number": "618-222-9244",
            "fax_number": "618-222-9248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANTOS",
        "first_name": "MELODY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-17",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2000146144",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Swansea, IL

Sources for this page

Verify at the official NPI Registry.