NPIMap

Individual provider Active NPI

Melissa D Johnson, DO

  • Family Medicine Physician
  • Fenton, MO
National Provider Identifier
1548284896
Registry record updated Nov 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2004008550 Issued in MO
Practice address
714 Gravois Rd
Suite 210
Fenton, MO 63026-7727
Phone
(636) 660-9850
Fax
(636) 660-9851
NPI assigned
Jul 27, 2006
Last updated
Nov 1, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2004008550 MO Primary

Addresses

Primary practice location

714 Gravois Rd
Suite 210
Fenton, MO 63026-7727

Mailing address

PO Box 23340
Saint Louis, MO 63156-3340
Phone (636) 660-9850

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040726000730 MO Practitioner - Family Practice 1850371105 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Missouri, Kansas City, School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
American Multispecialty Group IncGroup PAC ID 1658365572, 118 clinicians

Practice addresses (Care Compare)

714 Gravois Rd
Suite 210
Fenton, MO 63026-7723
Phone (636) 660-9850

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2004008550MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Patients First Health Care LLC Family Medicine Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: melissa.johnson.p1@direct.essehealth.nextgenshare.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541030400000",
    "number": "1548284896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23340",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631563340",
            "telephone_number": "636-660-9850",
            "fax_number": "636-660-9851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "714 GRAVOIS RD",
            "address_2": "SUITE 210",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630267727",
            "telephone_number": "636-660-9850",
            "fax_number": "636-660-9851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MELISSA",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-27",
        "last_updated": "2018-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2004008550",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fenton, MO

Sources for this page

Verify at the official NPI Registry.