Individual provider Active NPI

Kayli Malzahn Schwamb, O.D.

  • Optometrist
  • Chesterfield, MO
National Provider Identifier
1669750121
Registry record updated Nov 6, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2998 Issued in TN
Practice address
1028 Town and Country Crossing Dr
Chesterfield, MO 63017-0610
Phone
(636) 230-9190
Fax
(636) 230-9019
NPI assigned
Aug 1, 2011
Last updated
Nov 6, 2014By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 6, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2998 TN Primary

Addresses

Primary practice location

1028 Town and Country Crossing Dr
Chesterfield, MO 63017-0610

Mailing address

40 E North St
Eureka, MO 63025-1205
Phone (636) 200-4393

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120820001017 MO Practitioner - Optometry 1850548272 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Clarkson Optometry IncGroup PAC ID 0840411799, 82 clinicians

Practice addresses (Care Compare)

1028 Town and Country Crossing Dr
Chesterfield, MO 63017-0610
Phone (636) 230-9190

3122 S Grand Blvd
The Spec Shoppe
St Louis, MO 63118-1012
Phone (314) 450-7313

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2998TNMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Clarkson Optometry, Inc Optometrist CurrentSince Aug 20, 2014 Accepting new patients
Clarkson Optometry Inc Optometrist CurrentSince Aug 20, 2014 Accepting new patients
Clarkson Optometry Inc Optometrist Past Accepting new patients

Locations

1028 Town and Country Crossing Dr
Chesterfield, MO 63017
Phone (636) 230-9190

330 W Osage St
Pacific, MO 63069
Phone (636) 271-4500

3122 S Grand Blvd
Saint Louis, MO 63118
Phone (314) 450-7313

Interoperability endpoints

  • Direct secure messaging: kaylischwamb@direct.eyecare-partners.com

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

NPI Registry JSON

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

{
    "created_epoch": "1312156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415232000000",
    "number": "1669750121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 E NORTH ST",
            "city": "EUREKA",
            "state": "MO",
            "postal_code": "630251205",
            "telephone_number": "636-200-4393",
            "fax_number": "636-938-2650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1028 TOWN AND COUNTRY CROSSING DR",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630170610",
            "telephone_number": "636-230-9190",
            "fax_number": "636-230-9019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHWAMB",
        "first_name": "KAYLI",
        "middle_name": "MALZAHN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-08-01",
        "last_updated": "2014-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TN",
            "license": "2998",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chesterfield, MO

Sources for this page

Verify at the official NPI Registry.