Active NPI
Michael Cracchiolo, PA
- Physician Assistant
- Saint Louis, MO
National Provider Identifier
1891713350
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 104711
- Practice address
- 400 S Kingshighway Blvd
Saint Louis, MO 63110-1014 - Phone
- (314) 747-3000
- Fax
- (314) 747-4876
- NPI assigned
- Jul 17, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 104711 | MO | Primary |
Addresses
Primary practice location
400 S Kingshighway Blvd
Saint Louis, MO 63110-1014
Mailing address
660 S Euclid Ave
C B 8072
Saint Louis, MO 63110-1010
Phone (314) 747-3000
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ENROLLED | Medicaid | IL | |
| 1891713350 | Medicaid | MO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1516752000000",
"number": "1891713350",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "660 S EUCLID AVE",
"address_2": "C B 8072",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631101010",
"telephone_number": "314-747-3000",
"fax_number": "314-747-4876"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 S KINGSHIGHWAY BLVD",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631101014",
"telephone_number": "314-747-3000",
"fax_number": "314-747-4876"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRACCHIOLO",
"first_name": "MICHAEL",
"name_prefix": "Mr.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-17",
"last_updated": "2018-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MO",
"license": "104711",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "ENROLLED",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1891713350",
"state": "MO"
}
],
"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 Jan 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.