Individual provider Active NPI

Jeffrey D Todd, PA-C

  • Physician Assistant
  • Chesterfield, MO
National Provider Identifier
1578635488
Registry record updated Nov 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2009010356 Issued in MO
Practice address
17300 N Outer 40 Rd Ste 201
Chesterfield, MO 63005-1364
Phone
(636) 778-2900
Fax
(636) 778-2828
NPI assigned
Nov 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2009010356 MO Primary

Addresses

Primary practice location

17300 N Outer 40 Rd Ste 201
Chesterfield, MO 63005-1364

Mailing address

17300 N Outer 40 Rd Ste 201
Chesterfield, MO 63005-1364
Phone (636) 778-2900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090811000331 MO Practitioner - Physician Assistant 8224039607

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
2911 Healthcare LLCGroup PAC ID 6204242803, 2 clinicians

Practice addresses (Care Compare)

14825 N Outer 40 Rd
Suite 310
Chesterfield, MO 63017-2152
Phone (314) 451-2225

Hospital & facility affiliations

  • St Lukes Hospital Hospital, Chesterfield, MO, CCN 260179

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1562OKMDOccupational Therapy Assistant

Hospital & facility affiliations 1

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": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732233600000",
    "number": "1578635488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17300 N OUTER 40 RD STE 201",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630051364",
            "telephone_number": "636-778-2900",
            "fax_number": "636-778-2828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17300 N OUTER 40 RD STE 201",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630051364",
            "telephone_number": "636-778-2900",
            "fax_number": "636-778-2828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TODD",
        "first_name": "JEFFREY",
        "middle_name": "D",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-15",
        "last_updated": "2024-11-22",
        "certification_date": "2024-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2009010356",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chesterfield, MO

Sources for this page

Verify at the official NPI Registry.