Individual provider Active NPI

Melissa Ann Kershaw, D.O.

  • Cardiovascular Disease Physician
  • Florissant, MO
National Provider Identifier
1518178730
Registry record updated Apr 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
2012015978 Issued in MO
Practice address
1225 Graham Rd Ste C-2310
Florissant, MO 63031-8023
Phone
(314) 953-6300
NPI assigned
May 28, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 036.129923 IL
Cardiovascular Disease Physician 207RC0000X 5101018436 MI
Cardiovascular Disease Physician 207RC0000X 2012015978 MO Primary

Addresses

Primary practice location

1225 Graham Rd Ste C-2310
Florissant, MO 63031-8023

Mailing address

1225 Graham Rd Ste C-2310
Florissant, MO 63031-8023
Phone (314) 953-6300

Other practice location 1

6810 State Route 162
Ste 102
Maryville, IL 62062-8501
Phone (618) 288-4076

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, MO2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20130121000088 IL Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 9133372378 Reassigns benefits to 1 organization
I20130215000533 MO Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 9133372378 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fairview Heights Medical Group SCGroup PAC ID 6800784083, 448 clinicians

Practice addresses (Care Compare)

1 Memorial Dr
Alton, IL 62002-6722
Phone (618) 463-7240

11133 Dunn Rd
Saint Louis, MO 63136-6163
Phone (314) 653-5643

11155 Dunn Rd
Suite 109N
Saint Louis, MO 63136-6148
Phone (314) 953-8799

1225 Graham Rd
Suite 1220B
Florissant, MO 63031-8012
Phone (618) 466-6616

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.129923ILMDCardiovascular Disease Physician
5101018436MIMDCardiovascular Disease Physician
2012015978MOMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Heights Medical Group SC CurrentSince Nov 1, 2012 Accepting new patients
Fairview Heights Medical Group SC CurrentSince Nov 1, 2012 Accepting new patients

Locations

1 Memorial Dr
Alton, IL 62002
Phone (618) 463-7240

6810 State Route 162
Ste 102
Maryville, IL 62062
Phone (618) 288-4076

1225 Graham Rd
Ste C-2310
Florissant, MO 63031
Phone (314) 953-6300

670 Mason Ridge Center Dr
Ste 300
Saint Louis, MO 63141
Phone (314) 953-8250

11155 Dunn Rd
Ste 109N
Saint Louis, MO 63136
Phone (314) 837-3784

Interoperability endpoints

  • Direct secure messaging: mkershaw11246@direct.carenet.org

Organizations & group practices 2

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 3

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": "1180310400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617321600000",
    "number": "1518178730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1225 GRAHAM RD STE C-2310",
            "city": "FLORISSANT",
            "state": "MO",
            "postal_code": "630318023",
            "telephone_number": "314-953-6300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 GRAHAM RD STE C-2310",
            "city": "FLORISSANT",
            "state": "MO",
            "postal_code": "630318023",
            "telephone_number": "314-953-6300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6810 State Route 162",
            "address_2": "Ste 102",
            "address_purpose": "LOCATION",
            "city": "Maryville",
            "state": "IL",
            "postal_code": "620628501",
            "country_code": "US",
            "telephone_number": "618-288-4076",
            "fax_number": "618-288-4215",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KERSHAW",
        "first_name": "MELISSA",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-28",
        "last_updated": "2021-04-02",
        "certification_date": "2021-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IL",
            "license": "036.129923",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MI",
            "license": "5101018436",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MO",
            "license": "2012015978",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1225 Graham Rd Ste C-2310",
            "city": "Florissant",
            "state": "MO",
            "country_code": "US",
            "postal_code": "630318023",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Florissant, MO

Sources for this page

Verify at the official NPI Registry.