Individual provider Active NPI

Patrick B McDonough, MD

  • Gastroenterology Physician
  • Bridgeton, MO
National Provider Identifier
1770791832
Registry record updated Nov 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
2007012223 Issued in MO
Practice address
12266 De Paul Dr Ste 300
Bridgeton, MO 63044-2562
Phone
(314) 291-8824
NPI assigned
May 20, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 2007012223 MO Primary

Addresses

Primary practice location

12266 De Paul Dr Ste 300
Bridgeton, MO 63044-2562

Mailing address

PO Box 955534
Saint Louis, MO 63195-5534

Other practice location 1

12277 De Paul Dr
Suite 401
Bridgeton, MO 63044-2516
Phone (314) 291-8824

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address pmcdonough21492@direct-ehr-ssmhc.com Direct
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071001000347 MO Practitioner - GastroenterologyPractitioner - Internal Medicine 1658466073 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
University of Missouri, Columbia School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SSM Medical Group IncGroup PAC ID 6608776299, 565 clinicians

Practice addresses (Care Compare)

1035 Bellevue Ave
Suite 500
Saint Louis, MO 63117-1843
Phone (314) 925-4770

12277 De Paul Dr
Bridgeton, MO 63044-2540
Phone (314) 291-8824

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy90
Upper gastrointestinal (GI) endoscopy for acid reflux136

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
SSM Medical Group Inc. CurrentSince Aug 1, 2018 Accepting new patients
SSM Medical Group, Inc. Gastroenterology CurrentSince Aug 1, 2018 Accepting new patients
SSM Health Care St. Louis Past Accepting new patients
Raymond F. Mohrman MD PC Gastroenterology Past Accepting new patients
SSM Depaul Medical Group, Inc. Past Accepting new patients

Locations

3221 McKelvey Rd
Ste 301
Bridgeton, MO 63044

12277 De Paul Dr
Ste 500
Bridgeton, MO 63044

12266 De Paul Dr
Ste 300
Bridgeton, MO 63044
Phone (314) 291-2663

12277 De Paul Dr
Ste 401
Bridgeton, MO 63044
Phone (314) 628-1408

14021 New Halls Ferry Rd
Florissant, MO 63033
Phone (314) 839-0910

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

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

Organizations & group practices 5

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 3

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": "1179619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604966400000",
    "number": "1770791832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 955534",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631955534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12266 DE PAUL DR STE 300",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442562",
            "telephone_number": "314-291-8824"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12277 De Paul Dr",
            "address_2": "Suite 401",
            "address_purpose": "LOCATION",
            "city": "Bridgeton",
            "state": "MO",
            "postal_code": "630442516",
            "country_code": "US",
            "telephone_number": "314-291-8824",
            "fax_number": "314-291-2663",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCDONOUGH",
        "first_name": "PATRICK",
        "middle_name": "B",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-20",
        "last_updated": "2020-11-10",
        "certification_date": "2020-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MO",
            "license": "2007012223",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pmcdonough21492@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "pmcdonough21492@direct-ehr-ssmhc.com",
            "address_1": "12266 De Paul Dr Ste 300",
            "city": "Bridgeton",
            "state": "MO",
            "country_code": "US",
            "postal_code": "630442562",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "12266 De Paul Dr Ste 300",
            "city": "Bridgeton",
            "state": "MO",
            "country_code": "US",
            "postal_code": "630442562",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bridgeton, MO

Sources for this page

Verify at the official NPI Registry.