Omar Maatouk, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

2019039182 Issued in MO

Practice address

4129 N Highway 67
Florissant, MO 63034-2825

Phone

(314) 355-6390

NPI assigned

Jul 2, 2013

Last updated

Nov 3, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Electronic endpoints 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: omaatouk343093@direct-ehr-ssmhc.com
• Direct secure messaging: omaatouk63432@direct.nemours.org

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.

• SSM Health Care St Louis

  dba SSM Health St Clare Fenton

  • Emergency Medicine Physician
  • Fenton, MO
  • NPI 1275586174
  Medicare reassignment NPD
• SSM Cardinal Glennon Childrens Hospital

  dba SSM Health Cardinal Glennon Children's Hospital

  • Pediatrics Physician
  • O'Fallon, IL
  • NPI 1174577670

  MO

  Medicare reassignment NPD
• SSM Cardinal Glennon Children's Hospital

  dba SSM Health Cardinal Glennon Pediatrics

  • Pediatrics Physician
  • Warrenton, MO
  • NPI 1962573212
  NPD
• SSM Cardinal Glennon Childrens Hospital

  dba SSM Health Cardinal Glennon Pediatrics

  • Pediatrics Physician
  • Saint Louis, MO
  • NPI 1073568226
  NPD
• SSM Health Care St. Louis

  dba SSM Health DePaul Hospital

  • Cardiovascular Disease Physician
  • Bridgeton, MO
  • NPI 1376598599
  NPD
• Ozarks Medical Center

  dba Ozarks Healthcare

  • General Acute Care Hospital
  • West Plains, MO
  • NPI 1831115641
  NPD (past)

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

{
    "created_epoch": "1372723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604361600000",
    "number": "1720428915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4129 N HIGHWAY 67",
            "city": "FLORISSANT",
            "state": "MO",
            "postal_code": "630342825",
            "telephone_number": "314-355-6390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4129 N HIGHWAY 67",
            "city": "FLORISSANT",
            "state": "MO",
            "postal_code": "630342825",
            "telephone_number": "314-355-6390"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "49 Fallon Ave",
            "address_purpose": "LOCATION",
            "city": "Seaford",
            "state": "DE",
            "postal_code": "199731577",
            "country_code": "US",
            "telephone_number": "302-629-5030",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAATOUK",
        "first_name": "OMAR",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-07-02",
        "last_updated": "2020-11-03",
        "certification_date": "2020-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "LA",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "DE",
            "license": "C10011752",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2019039182",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "DE",
            "license": "C10011752",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "omaatouk343093@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "omaatouk343093@direct-ehr-ssmhc.com",
            "address_1": "4129 N Highway 67",
            "city": "Florissant",
            "state": "MO",
            "country_code": "US",
            "postal_code": "630342825",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Luxottica of America Inc. (Pearle Vision #1872)
• Stacy Lyles
• Shaneda Lynch
• Lynn in-Home Health Services, Inc
• Lynn in-Home Health Services, Inc
• Paul Stanley Mace, D.D.S.
• Stephanie C Macklin
• Lanette Madison
• Gena L Magee
• Jacqueline K Maginn, OTR

• Pediatrics Physician in Florissant, MO
• Providers in Florissant, MO by specialty
• Pediatrics Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.