Matthew A Beckerdite, MD
Individual provider Active NPI Family Medicine Physician · Ofallon, MO
NPI 1821062266 · NPPES record last updated Sep 3, 2021
Key facts
- NPI
- 1821062266
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 2000161367 (MO)
- Practice address
- 2630 State Highway K
Ste 100
Ofallon, MO 63368 - Phone
- (636) 240-5454
- NPI assigned
- Feb 14, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 7
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- University of Missouri, Columbia School of Medicine, 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Physician Groups LC
Practice addresses (Care Compare)
1110 Highlands Plaza Dr E
Saint Louis, MO 63110-1351
Phone (314) 273-0195
2630 Hwy K
O Fallon, MO 63368-6624
Phone (636) 240-5454
Hospital & facility affiliations
- Elara Caring
- Missouri Baptist Medical Center
- Progress West Hospital
- Barnes-Jewish St Peters Hospital
- Mercy Hospital St Louis
- Barnes-Jewish West County Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
| Skin biopsy | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070524000646 | MO | Practitioner - Family Practice | 5698872703 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2000161367 | MO | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Physician Groups LC | Family Medicine | Current |
Accepting new patients |
| Physician Groups LC | Current |
Accepting new patients | |
| Mercy Clinic East Communities | Family Medicine | Current |
Accepting new patients |
| Mercy Clinic East Communities | Family Medicine | Current |
Accepting new patients |
Locations
300 Winding Woods Dr
Ste 222
O Fallon, MO 63366
Phone (636) 256-5350
2630 Highway K
Ste 100
O Fallon, MO 63368
Phone (636) 240-5454
2630 Highway K
O Fallon, MO 63368
Phone (636) 240-5454
621 S New Ballas Rd
Ste 189A
Saint Louis, MO 63141
Phone (314) 251-6335
621 S New Ballas Rd
Ste 4017B
Saint Louis, MO 63141
Phone (314) 872-9192
615 S New Ballas Rd
Saint Louis, MO 63141
Phone (314) 251-4687
969 N Mason Rd
Ste 160
Saint Louis, MO 63141
Phone (314) 434-8828
Interoperability endpoints
- mbeckerdite238@directc.mercy.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 2000161367 | MO | Yes |
Addresses
Primary practice location
2630 State Highway K
Ste 100
Ofallon, MO 63368
Mailing address
2630 State Highway K
Ste 100
Ofallon, MO 63368
Phone (636) 240-5454
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821062266 | Medicaid | MO | |
| 080185383 | Other | MO | RAILROAD MEDICARE |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| FHIR URL | https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ | Health Information Exchange (HIE) |
Other providers in Ofallon, MO
- Bethany Arkills
- Alissa Ballard
- Bankhead Orthodontics DDS PC
- Aliece Nicole Barklage
- Tara Lynn Barnes-Cherry
- Danielle R Berra
- Sarah Biondo
- Sara Birkemeier
- Terry Michael Blake
- Jacob Scott Bleyer
All providers in Ofallon, MO · Family Medicine Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 3, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.