Mark Dayton Belcher, MD
Individual provider Active NPI Anesthesiology Physician · Saint Louis, MO
NPI 1528088523 · NPPES record last updated Aug 15, 2014
Key facts
- NPI
- 1528088523
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Anesthesiology Physician 207L00000X
- License
- 2000166660 (MO)
- Practice address
- 4116 Von Talge Rd
Suite B
Saint Louis, MO 63128-1957 - Phone
- (314) 892-8787
- NPI assigned
- Jul 20, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 8
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- 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 |
|---|---|---|---|---|
| I20190930001943 | IL | Practitioner - Anesthesiology | 8628976347 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northeast Missouri Imaging Associates, Inc. | Past | Accepting new patients | |
| Medical Care LLC | Past | Accepting new patients | |
| Williamson Memorial Hospital LLC | Past | Accepting new patients | |
| Professional Anesthesia Service,Inc. | Anesthesiology | Past | Accepting new patients |
| Hannibal Regional Healthcare System Inc | Past | Accepting new patients | |
| SSM Health Care St. Louis | Past | Accepting new patients |
Interoperability endpoints
- https://fhir.fhirpoint.open.allscripts.com/fhirroute/open/10040602
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 2000166660 | MO | Yes |
Addresses
Primary practice location
4116 Von Talge Rd
Suite B
Saint Louis, MO 63128-1957
Mailing address
1604 Brett Ridge Dr
Dardenne Prairie, MO 63368-7338
Phone (636) 734-8778
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 205218829 | Medicaid | MO |
Other providers in Saint Louis, MO
- Bel Oak of Lemay LLC
- Seema Belani
- James Edward Belcher
- Jeff Belcher
- Kim Anne Belcher
- Jennifer Ann Belden
- Catalina Belean
- Danielle M Beler
- Mark E Belew
- Brandi Belger
All providers in Saint Louis, MO · Anesthesiology 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 Aug 15, 2014. 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.