Active NPI
Mark Miller Shuldberg, D.O.
- Anatomic Pathology & Clinical Pathology Physician
- Saint Louis, MO
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- 2013010528
- Practice address
- 3635 Vista Ave
Saint Louis, MO 63110-2539 - Phone
- (314) 577-8782
- NPI assigned
- Jul 1, 2010
- Last updated
- May 2, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hematology (Pathology) Physician | 207ZH0000X | 2013010528 | MO | |
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 2013010528 | MO | Primary |
Addresses
Primary practice location
3635 Vista Ave
Saint Louis, MO 63110-2539
Mailing address
1402 S Grand Blvd
Pathology
Saint Louis, MO 63104-1004
Phone (314) 577-8782
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO, CO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Pathology
- Education
- Other, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
106 Blanca Ave
Alamosa, CO 81101-2340
Phone (719) 589-2511
Hospital & facility affiliations
Merit-based Incentive Payment System (MIPS)
- Final score
- 85.41 of 100
- Quality
- 70.25
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 67.83
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2013010528 | MO | MD | Anatomic Pathology & Clinical Pathology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| SSM Cardinal Glennon Childrens Hospital | Current | Accepting new patients | |
| SSM Cardinal Glennon Children's Hospital | Current | Accepting new patients |
Locations
7344 Solutions Ctr
Chicago, IL 60677
Phone (314) 989-6189
6800 State Route 162
Maryville, IL 62062
Phone (618) 288-4095
1465 S Grand Blvd
Saint Louis, MO 63104
Phone (314) 268-4070
Organizations & group practices 3
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.
-
dba San Luis Valley Health Regional Medical Center
- General Acute Care Hospital
- Alamosa, CO
- NPI 1235181744
-
dba SSM Health Cardinal Glennon Children's Hospital
- Pediatrics Physician
- O'Fallon, IL
- NPI 1174577670
MO
-
dba SSM Health Cardinal Glennon Pediatrics
- Pediatrics Physician
- Warrenton, MO
- NPI 1962573212
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba San Luis Valley Health Regional Medical Center
- General Acute Care Hospital
- Alamosa, CO
- NPI 1235181744
-
dba Rio Grande Hospital
- Critical Access Hospital
- Del Norte, CO
- NPI 1396783981
-
dba Rio Grande Hospital Clinic at South Fork
- Critical Access Hospital Clinic/Center
- South Fork, CO
- NPI 1699266718
-
dba Creede Family Practice of Rio Grande Hospital
- Critical Access Hospital Clinic/Center
- Creede, CO
- NPI 1851882989
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1277942400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1462147200000",
"number": "1881905164",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1402 S GRAND BLVD",
"address_2": "PATHOLOGY",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631041004",
"telephone_number": "314-577-8782"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3635 VISTA AVE",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631102539",
"telephone_number": "314-577-8782"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHULDBERG",
"first_name": "MARK",
"middle_name": "MILLER",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-07-01",
"last_updated": "2016-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "207ZH0000X",
"taxonomy_group": "",
"desc": "Pathology, Hematology",
"state": "MO",
"license": "2013010528",
"primary": false
},
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "MO",
"license": "2013010528",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2016; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.