NPIMap

Individual provider Active NPI

Paul R Ganninger, M.D.

  • Family Medicine Physician
  • Chesterfield, MO
National Provider Identifier
1588625693
Registry record updated Feb 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2003003397 Issued in MO
Practice address
1585 Woodlake Dr
Suite 100
Chesterfield, MO 63017-5740
Phone
(314) 434-4278
Fax
(314) 851-4466
NPI assigned
Mar 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2015

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 2003003397 MO Primary

Addresses

Primary practice location

1585 Woodlake Dr
Suite 100
Chesterfield, MO 63017-5740

Mailing address

PO Box 23340
Saint Louis, MO 63156-3340
Phone (314) 434-4278

Other identifiers 1

IdentifierTypeStateIssuer
209094002MedicaidMO

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
I20100723000038 MO Practitioner - Family Practice 1254463490 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Saint Louis University School of Medicine, 2000
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
Aging Well Health Care, LLCGroup PAC ID 1153232038, 236 clinicians

Practice addresses (Care Compare)

1585 Woodlake Dr
Chesterfield, MO 63017-5740
Phone (314) 434-4278

7212 Balson Ave
Saint Louis, MO 63130-3001

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions19
Removal of nail tissue12
Removal or shaving of skin growth15
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2003003397MOMDFamily Medicine Physician

Interoperability endpoints

  • Direct secure messaging: paul.ganninger.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 and National Provider Directory roles.

Hospital & facility affiliations 8

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": "1143590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424217600000",
    "number": "1588625693",
    "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": "314-434-4278",
            "fax_number": "314-851-4466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1585 WOODLAKE DR",
            "address_2": "SUITE 100",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630175740",
            "telephone_number": "314-434-4278",
            "fax_number": "314-851-4466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANNINGER",
        "first_name": "PAUL",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-29",
        "last_updated": "2015-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2003003397",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "209094002",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chesterfield, MO

Sources for this page

Verify at the official NPI Registry.