Individual provider Active NPI

Micah Schenck

  • Primary Care Nurse Practitioner
  • Saint Louis, MO
National Provider Identifier
1831882786
Registry record updated Jun 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
2023023144 Issued in MO
Practice address
12200 Weber Hill Rd Ste 100
Saint Louis, MO 63127-1569
Phone
(314) 698-2500
NPI assigned
May 29, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 2017035413 MO
Primary Care Nurse Practitioner 363LP2300X 2023023144 MO Primary

Addresses

Primary practice location

12200 Weber Hill Rd Ste 100
Saint Louis, MO 63127-1569

Mailing address

2306 Viminal CT
Fenton, MO 63026-2223
Phone (314) 809-1512

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230804000529 MO Practitioner - Nurse Practitioner 3274994488 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Missouri, Columbia School of Medicine, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mercy Clinic East CommunitiesGroup PAC ID 7214827922, 573 clinicians

Practice addresses (Care Compare)

12200 Weber Hill Rd
Suite 100
Saint Louis, MO 63127-1569
Phone (314) 698-2500

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
2017035413MOMDRegistered Nurse
2023023144MOMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic East Communities CurrentSince Aug 7, 2023 Accepting new patients

Locations

621 S New Ballas Rd
Ste 189A
Saint Louis, MO 63141
Phone (314) 251-6335

12200 Weber Hill Rd
Ste 100
Saint Louis, MO 63127
Phone (314) 698-2400

621 S New Ballas Rd
Ste 4017B
Saint Louis, MO 63141
Phone (314) 872-9192

Organizations & group practices 1

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": "1685318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686960000000",
    "number": "1831882786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2306 VIMINAL CT",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630262223",
            "telephone_number": "314-809-1512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12200 WEBER HILL RD STE 100",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631271569",
            "telephone_number": "314-698-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHENCK",
        "first_name": "MICAH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-05-29",
        "last_updated": "2023-06-17",
        "certification_date": "2023-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MO",
            "license": "2017035413",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MO",
            "license": "2023023144",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.