Individual provider Active NPI

Daniel J Scodary, M.D.

  • Neurological Surgery Physician
  • Saint Louis, MO
National Provider Identifier
1619965316
Registry record updated Apr 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
R8N28 Issued in MO
Practice address
10010 Kennerly Rd
Saint Louis, MO 63128-2106
Phone
(314) 525-1000
NPI assigned
Oct 7, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X ME127387 FL
Neurological Surgery Physician 207T00000X R8N28 MO Primary

Addresses

Primary practice location

10010 Kennerly Rd
Saint Louis, MO 63128-2106

Mailing address

2407 Country Pointe LN
Wentzville, MO 63385-5435
Phone (314) 960-0760

Other practice location 1

2407 Country Pointe Ln
Wentzville, MO 63385-5435
Phone (314) 960-0760

Other identifiers 4

IdentifierTypeStateIssuer
30173OtherMOBLUE CROSS BLUE SHIELD
PENDINGMedicaidFL
130004994OtherMORR MEDICARE
PENDINGOtherFLMEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, FL2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20090116000013 MO Practitioner - Neurosurgery 1456414630 Reassigns benefits to 3 organizations
I20191223001278 FL Practitioner - Neurosurgery 1456414630 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurosurgery
Education
St. Louis College of Physicians and Surgeons, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinic Pain Management LLCGroup PAC ID 5890922066, 24 clinicians

Practice addresses (Care Compare)

12700 Southfork Rd
Suite 155
Saint Louis, MO 63128-3276
Phone (314) 525-7780

15945 Clayton Rd
Suite 220
Ballwin, MO 63011-2491
Phone (636) 239-8097

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME127387FLMDNeurological Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Halifax Healthcare Systems Inc CurrentSince Mar 5, 2020 Accepting new patients
Mercy Clinic Pain Management, LLC CurrentSince Dec 25, 2023 Accepting new patients
SSM Medical Group Inc. CurrentSince Jan 1, 2015 Accepting new patients
Mercy Clinic Surgical Specialists, LLC CurrentSince Apr 26, 2021 Accepting new patients
SSM Medical Group, Inc. CurrentSince Aug 1, 2018 Accepting new patients
North County Neurosurgery, Inc Neurological Surgery Past Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

303 N Clyde Morris Blvd
Daytona Beach, FL 32114
Phone (386) 425-2285

15945 Clayton Rd
Ste 220CLAY
Ballwin, MO 63011
Phone (636) 239-8097

12266 De Paul Dr
Ste 100
Bridgeton, MO 63044
Phone (314) 738-2770

1551 Wall St
Ste 310
Saint Charles, MO 63303
Phone (636) 669-2268

1035 Bellevue Ave
Ste 500
Saint Louis, MO 63117
Phone (314) 647-1115

3555 Sunset Office Dr
Ste C100
Saint Louis, MO 63127
Phone (314) 238-9100

10012 Kennerly Rd
Ste 400
Saint Louis, MO 63128
Phone (314) 525-1258

621 S New Ballas Rd
Ste 3005B
Saint Louis, MO 63141
Phone (314) 251-7070

851 E 5th St
Ste 108
Washington, MO 63090
Phone (636) 239-4144

Organizations & group practices 7

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 4

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": "1128643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617753600000",
    "number": "1619965316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2407 COUNTRY POINTE LN",
            "city": "WENTZVILLE",
            "state": "MO",
            "postal_code": "633855435",
            "telephone_number": "314-960-0760",
            "fax_number": "636-332-0316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10010 KENNERLY RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631282106",
            "telephone_number": "314-525-1000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2407 Country Pointe Ln",
            "address_purpose": "LOCATION",
            "city": "Wentzville",
            "state": "MO",
            "postal_code": "633855435",
            "country_code": "US",
            "telephone_number": "314-960-0760",
            "fax_number": "636-332-0316",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SCODARY",
        "first_name": "DANIEL",
        "middle_name": "J",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-07",
        "last_updated": "2021-04-07",
        "certification_date": "2021-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "FL",
            "license": "ME127387",
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "MO",
            "license": "R8N28",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "30173",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "130004994",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "PENDING",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.