Active NPI
Missouri Mso LLC
- Family Medicine Physician
- Florissant, MO
National Provider Identifier
1538041769
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- MISSOURI MSO LLC
- Practice address
- 1501 Charbonier Rd
Florissant, MO 63031-5308 - Phone
- (212) 734-6621
- NPI assigned
- Jul 21, 2025
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Samuel Kohn
- Title
- Manager
- Phone
- (347) 631-6775
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
1501 Charbonier Rd
Florissant, MO 63031-5308
Mailing address
4770 White Plains Rd
Bronx, NY 10470-1136
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250909002506 | MO | Part B Supplier - Clinic/Group Practice | 3274035035 |
Receives reassigned benefits from 22 practitioners Practice locations: Florissant, MO |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 22
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Psychiatric/Mental Health Nurse Practitioner
- Saint Louis, MO
- NPI 1528492907
MO
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1753056000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1767830400000",
"number": "1538041769",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4770 WHITE PLAINS RD",
"city": "BRONX",
"state": "NY",
"postal_code": "104701136"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1501 CHARBONIER RD",
"city": "FLORISSANT",
"state": "MO",
"postal_code": "630315308",
"telephone_number": "212-734-6621"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MISSOURI MSO LLC",
"organizational_subpart": "NO",
"enumeration_date": "2025-07-21",
"last_updated": "2026-01-08",
"certification_date": "2026-01-08",
"status": "A",
"authorized_official_last_name": "KOHN",
"authorized_official_first_name": "SAMUEL",
"authorized_official_title_or_position": "MANAGER",
"authorized_official_telephone_number": "347-631-6775"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Florissant, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.