Individual provider Active NPI

Kevin L Queen, A.A.

  • Anesthesiologist Assistant
  • Saint Louis, MO
National Provider Identifier
1578897054
Registry record updated Sep 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiologist AssistantTaxonomy code 367H00000X
License
2009029105 Issued in MO
Practice address
615 S New Ballas Rd
Dept. of Anesthesia
Saint Louis, MO 63141-8221
Phone
(314) 251-6000
NPI assigned
Sep 30, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiologist Assistant 367H00000X 2009029105 MO Primary

Addresses

Primary practice location

615 S New Ballas Rd
Dept. of Anesthesia
Saint Louis, MO 63141-8221

Mailing address

339 Consort Dr
Ballwin, MO 63011-4439
Phone (636) 386-9224

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091028000516 MO Practitioner - Anesthesiology Assistant 9133266869 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SSM Health Slu Hospital Anesthesia Physician Billing LLCGroup PAC ID 3274842331, 98 clinicians
Orthomed Staffing LLCGroup PAC ID 9638429178, 373 clinicians

Practice addresses (Care Compare)

1201 S Grand Blvd
Saint Louis, MO 63104-1016
Phone (314) 257-8000

1225 S Grand Blvd
Saint Louis, MO 63104-1016
Phone (314) 257-8000

5139 Mattis Rd
Suite 100
Saint Louis, MO 63128-2250
Phone (469) 863-9978

Hospital & facility affiliations

  • SSM Health Saint Louis University Hospital Hospital, Saint Louis, MO, CCN 260105

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Associate of Arts

State licenses

LicenseStateTypeSpecialty
2009029105MOMDAnesthesiologist Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Orthomed Staffing LLC CurrentSince Aug 7, 2023 Accepting new patients
SSM Health Slu Hospital Anesthesia Physician Billing, LLC Anesthesiologist Assistant CurrentSince Mar 15, 2021 Accepting new patients

Locations

17050 Baxter Rd
Ste 110
Chesterfield, MO 63005
Phone (636) 537-0122

305 N Keene St
Ste 107
Columbia, MO 65201
Phone (573) 239-3310

211 NE 54th St
Ste 100
Kansas City, MO 64118
Phone (816) 455-4214

200 NE 54th St
Unit 200
Kansas City, MO 64118

1050 Old des Peres Rd
Ste 150
Saint Louis, MO 63131
Phone (314) 396-9517

10435 Clayton Rd
Ste 110
Saint Louis, MO 63131
Phone (314) 576-1400

5139 Mattis Rd
Ste 100
Saint Louis, MO 63128
Phone (314) 207-8939

12639 Old Tesson Rd
Ste 130
Saint Louis, MO 63128
Phone (314) 729-0785

4594 S Lindbergh Blvd
Saint Louis, MO 63127
Phone (314) 842-2607

9701 Landmark Parkway Dr
Ste 100
Saint Louis, MO 63127
Phone (314) 396-9517

1040 Old des Peres Rd
Saint Louis, MO 63131
Phone (314) 729-9780

1201 S Grand Blvd
Saint Louis, MO 63104
Phone (314) 257-8222

5401 Veterans Memorial Pkwy
Ste 100
Saint Peters, MO 63376
Phone (636) 441-0906

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

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": "1254268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1254268800000",
    "number": "1578897054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "339 CONSORT DR",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630114439",
            "telephone_number": "636-386-9224",
            "fax_number": "636-200-4243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 S NEW BALLAS RD",
            "address_2": "DEPT. OF ANESTHESIA",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418221",
            "telephone_number": "314-251-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUEEN",
        "first_name": "KEVIN",
        "middle_name": "L",
        "name_prefix": "Mr.",
        "credential": "A.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-09-30",
        "last_updated": "2009-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "MO",
            "license": "2009029105",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.