NPIMap

Individual provider Active NPI

Carl A Mazzola, MD

  • Diagnostic Radiology Physician
  • Saint Charles, MO
National Provider Identifier
1801967138
Registry record updated Mar 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
2004001466 Issued in MO
Practice address
300 First Capitol Drive
St Charles, MO 63301
Phone
(636) 947-5444
Fax
(636) 947-5259
NPI assigned
Nov 10, 2006
Last updated
Mar 18, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 2004001466 MO Primary

Addresses

Primary practice location

300 First Capitol Drive
St Charles, MO 63301

Mailing address

220 Compass Point Drive
St Charles, MO 63301
Phone (636) 947-4480

Other identifiers 1

IdentifierTypeStateIssuer
209131705MedicaidMO

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
I20040909000798 MO Practitioner - Diagnostic Radiology 0648246744 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Saint Louis University School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Radiologic Imaging Consultants LLPGroup PAC ID 4587652748, 16 clinicians
SSM Medical Group IncGroup PAC ID 6608776299, 565 clinicians

Practice addresses (Care Compare)

100 Medical PLZ
Lake Saint Louis, MO 63367-1366
Phone (636) 625-5303

300 1St Capitol Dr
Saint Charles, MO 63301-2844
Phone (636) 947-5000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.5 of 100Reported as group
Quality
90
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2004001466MOMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Diagnostic Imaging Associates LTD Diagnostic Radiology CurrentSince Jun 1, 2005 Accepting new patients
SSM Medical Group Inc. CurrentSince Oct 6, 2025 Accepting new patients
SSM Medical Group, Inc. CurrentSince Oct 6, 2025 Accepting new patients
Radiologic Imaging Consultants, LLP Diagnostic Radiology CurrentSince Jan 1, 2024 Accepting new patients
Metro Imaging, LLC Diagnostic Radiology Past Accepting new patients

Locations

100 Medical Plz
Lake St Louis, MO 63367
Phone (636) 625-5200

220 Compass Point Dr
Saint Charles, MO 63301
Phone (636) 947-4480

300 1st Capitol Dr
Saint Charles, MO 63301
Phone (636) 669-2211

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

1715 Deer Tracks Trl
Ste 130
Saint Louis, MO 63131
Phone (314) 567-1856

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

232 S Woods Mill Rd
Town and Country, MO 63017
Phone (314) 205-6030

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

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": "1163116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710720000000",
    "number": "1801967138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 COMPASS POINT DRIVE",
            "city": "ST CHARLES",
            "state": "MO",
            "postal_code": "63301",
            "telephone_number": "636-947-4480",
            "fax_number": "636-947-9860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 FIRST CAPITOL DRIVE",
            "city": "ST CHARLES",
            "state": "MO",
            "postal_code": "63301",
            "telephone_number": "636-947-5444",
            "fax_number": "636-947-5259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAZZOLA",
        "first_name": "CARL",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-10",
        "last_updated": "2024-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MO",
            "license": "2004001466",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "209131705",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Charles, MO

Sources for this page

Verify at the official NPI Registry.