NPIMap

Organization Active NPI

Missouri Mso LLC

  • Family Medicine Physician
  • Florissant, MO
National Provider Identifier
1538041769
Registry record updated Jan 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MISSOURI MSO LLC
Practice address
1501 Charbonier Rd
Florissant, MO 63031-5308
Phone
(212) 734-6621
NPI assigned
Jul 21, 2025
Last updated
Jan 8, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2026

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)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 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 IDStateProvider typePAC IDDetails
O20250909002506 MO Part B Supplier - Clinic/Group Practice 3274035035 Receives reassigned benefits from 22 practitioners
Practice locations: Florissant, MO

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

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.

Verify at the official NPI Registry.