DR. MICHAEL SCOTT BOEDEFELD (NPI# 1043299548) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043299548 |
| Entity Type | Individual |
| Full Name | DR. MICHAEL SCOTT BOEDEFELD |
| Credential | MD |
| Practice Address |
1055 Bowles Ave Ste 202 Fenton MO 63026-2308 |
| Mailing Address |
4800 Mexico Rd Ste 101 Saint Peters MO 63376-1666 |
| Practice Telephone | 6363867222 |
| Practice Fax Number | 6363867810 |
| Mailing Telephone | 6364425035 |
| Mailing Fax Number | 6364425036 |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2020-10-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207L00000X | Anesthesiology | 2004009978 | MO | Allopathic & Osteopathic Physicians |
| Y | 207LP2900X |
Anesthesiology Specialization: Pain Medicine |
2004009978 | MO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 207320102 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 4800 Mexico Rd Ste 101, Saint Peters, MO 633761666 | 6364425035 |
| Street Address |
1055 BOWLES AVE STE 202 |
| City | FENTON |
| State | MO |
| Zip Code | 63026-2308 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205339074 | Pro Pain LLC | Anesthesiology | 1055 Bowles Ave Ste 202, Fenton, MO 63026-2308 | 2018-03-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871000372 | Allison Egler | Audiologist | 1011 Bowles Ave Ste 405, Fenton, MO 63026 | 2018-01-05 |
| 1629508213 | Holly Brooks Munson | Massage Therapist | 220 Copper Mountain Dr, Fenton, MO 63026 | 2017-06-15 |
| 1073978862 | Naomi Sharon | Nurse Practitioner | 1101 Bowles Avenue, Suite G50, Fenton, MO 63026 | 2015-12-21 |
| 1871981704 | Celtic Private Care of Il & Mo, LLC | In Home Supportive Care | 1653 Larkin Williams Road, Suite 201, Fenton, MO 63026 | 2014-12-30 |
| 1356747513 | Kristina Potts | Nurse Practitioner | 774 Gravois Bluffs Blvd Ste B, Fenton, MO 63026 | 2014-11-14 |
| 1245642420 | Physicians Health Group Medical Inc | General Practice | 960 S. Highway Dr, Fenton, MO 63026 | 2014-05-22 |
| 1598047409 | Kevin Eugene Bruce | Pharmacist | 1210 Sugar Creek, Fenton, MO 63026 | 2011-09-16 |
| 1215186382 | Concentra Health Services, Inc. | Clinic/Center | 128 Matrix Commons Dr., Fenton, MO 63026 | 2008-09-15 |
| 1790954410 | Castlewood Treatment Center LLC | Community/Behavioral Health | 1855 Bowles Ave, Suite 210, Fenton, MO 63026 | 2008-02-27 |
| 1073703617 | Christina R Baeres | Dietitian, Registered | 38 Majestic Ct, Fenton, MO 63026 | 2007-07-30 |
| Find all providers in zip 63026 | ||||
| Taxonomy Code | 207LP2900X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Anesthesiology |
| Specialization | Pain Medicine |
| An anesthesiologist who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic and/or cancer pain in both hospital and ambulatory settings. Patient care needs are also coordinated with other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Anesthesiology, 2007. http://www.theaba.org/; American Osteopathic Board of Anesthesiology, 2007, http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Anesthesiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Anesthesiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205339074 | Pro Pain LLC | Anesthesiology | 1055 Bowles Ave Ste 202, Fenton, MO 63026-2308 | 2018-03-17 |
| 1316307861 | Pain Management Center of Michigan Plc | Anesthesiology | 445 N Fenway Dr, Fenton, MI 48430-2666 | 2016-02-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679088900 | Midwest Pain Management Clinic LLC | Anesthesiology | 1011 Old Olive Way Apt 403, Creve Coeur, MO 63141-5959 | 2017-12-08 |
| 1235579749 | Nicki D Rippeteau | Anesthesiology | 4606 E 184th St, Belton, MO 64012-8323 | 2013-06-28 |
| 1518217322 | Advanced Anesthesia and Pain Management, LLC | Anesthesiology | 12805 Topping Woods Estate Drive, St. Louis, MO 63131 | 2012-09-19 |
| 1265794911 | Regeneration Orthopedics, LLC | Anesthesiology | 6 Mcbride & Son Center Dr., Ste 204, Chesterfield, MO 63005 | 2012-06-08 |
| 1265727572 | Rebecca A Sanders | Anesthesiology | 1002 Mcintosh Cir Ste 6, Joplin, MO 64804-3600 | 2011-06-15 |
| 1457655748 | Melrich Inc | Anesthesiology | 625 Cannonbury Dr, Saint Louis, MO 63119-5312 | 2010-12-31 |
| 1700016250 | Oluseyi Fadegbola Ogundimu | Anesthesiology | 661 Fisher Dr, Sullivan, MO 63080-1533 | 2009-07-17 |
| 1467640235 | Shavonne L. Danner, M.d., L.L.C. | Anesthesiology | 2525 Glenn Henden Dr, Liberty, MO 64068 | 2007-10-05 |
| 1225171648 | Benjamin A Lampert | Anesthesiology | 1730 E Portland St, Springfield, MO 65804-1311 | 2007-02-15 |
| 1972651578 | Advanced Pain Specialists, Inc. | Anesthesiology | 7510 Big Bend Blvd, Saint Louis, MO 63119-2104 | 2007-01-08 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.