Kenneth G Smith (NPI# 1154327534, PAC ID# 7012816390) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is GENERAL SURGERY.
| Nation Provider ID (NPI) | 1154327534 |
| PAC ID by PECOS | 7012816390 |
| Professional Enrollment ID | I20050104000629 |
| Full Name | Kenneth G Smith |
| Organization Legal Name | SIGNATURE MEDICAL GROUP, INC. |
| Address |
12122 Tesson Ferry Rd Suite 101 Saint Louis MO 63128-1772 |
| Phone Number | 3148426183 |
| Gender | M |
| Credential | MD |
| Medical School | SOUTHERN ILLINOIS UNIVERSITY SCHOOL OF MEDICINE |
| Graduation Year | 1993 |
| Primary Specialty | GENERAL SURGERY |
| Group Practice PAC ID | 4880598291 |
| Number of Group Practice Members | 71 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 260077 | ST ANTHONY'S MEDICAL CENTER |
| 260108 | MISSOURI BAPTIST MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 12122 Tesson Ferry Rd, Suite 101, Saint Louis, MO 63128-1772 | 3148426183 | SIGNATURE MEDICAL GROUP, INC. |
| Measure Identifier | Measure Title | Performance Rate | Reporting Mechanism |
|---|---|---|---|
| ACI_EC_TRANS_PPHI_1 | Security Risk Analysis | % |
| Organization Legal Name | SIGNATURE MEDICAL GROUP, INC. |
| Physicians | 62 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Brian A Fissel | Orthopedic Surgery | Signature Medical Group, Inc. | 12639 Old Tesson Rd, Suite 115, Saint Louis, MO 63128-2786 |
| Misty D Wheelock | Nurse Practitioner | Signature Medical Group, Inc. | 845 N New Ballas Ct, Suite 200, Saint Louis, MO 63141-7169 |
| Selwyn Picker | Neurosurgery | Signature Medical Group, Inc. | 621 S Ballas Rd, 310a, Saint Lous, MO 63141-5314 |
| Matthew Melander | Orthopedic Surgery | Signature Medical Group, Inc. | 9323 Phoenix Village Pkwy, O Fallon, MO 63368-4281 |
| Ann Marie S Rockamann | Obstetrics/gynecology | Signature Medical Group, Inc. | 3023 N Ballas Rd, Suite 600d, Saint Louis, MO 63131-2332 |
| Craig R Ruble | Orthopedic Surgery | Signature Medical Group, Inc. | 1390 Us Hwy 61 G1000, Festus, MO 63028-4136 |
| John E Delrosario | Physical Medicine and Rehabilitation | Signature Medical Group, Inc. | 10010 Kennerly Rd, Suite 4, Saint Louis, MO 63128-2106 |
| Theresa A Boxdorfer | Nurse Practitioner | Signature Medical Group, Inc. | 12639 Old Tesson Rd, Suite 115, Saint Louis, MO 63128-2786 |
| Dennis A Dusek | Orthopedic Surgery | Signature Medical Group, Inc. | 12639 Old Tesson Rd, Suite 115, Saint Louis, MO 63128-2786 |
| Alexandria N Ruzicka | Physician Assistant | Signature Medical Group, Inc. | 12639 Old Tesson Rd, Suite 115, Saint Louis, MO 63128-2786 |
| Street Address |
12122 TESSON FERRY RD SUITE 101 |
| City | SAINT LOUIS |
| State | MO |
| Zip | 63128-1772 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Rhoderic P Mirkin | Orthopedic Surgery | Signature Medical Group, Inc. | 12122 Tesson Ferry Rd, Suite 100, Saint Louis, MO 63128-1772 |
| Michael A Smith | General Surgery | Signature Medical Group, Inc. | 12122 Tesson Ferry Rd, Suite 101, Saint Louis, MO 63128-1772 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Rachel M Ott | Nurse Practitioner | St Anthony's Physician Organization | 12700 Kennerly Rd, Suite 220, Saint Louis, MO 63128 |
| Shephali H Wulff | Infectious Disease | Infectious Diseases PC | 330 1st Capitol Dr, Suite 260, St Charles, MO 63128 |
| Marie E Wehner | Optometry | Vision Care Consultants Inc | 12121 Tesson Ferry Professional Ctr, Saint Louis, MO 63128-1250 |
| David Brian Seibel | Optometry | Vision Care Consultants Inc | 12121 Tesson Ferry Professional Ctr, Saint Louis, MO 63128-1250 |
| Craig Mathew Brawley | Optometry | Vision Care Consultants Inc | 12121 Tesson Ferry Professional Ctr, Saint Louis, MO 63128-1250 |
| John D Friederich | Optometry | Vision Care Consultants Inc | 12121 Tesson Ferry Professional Ctr, Saint Louis, MO 63128-1250 |
| Michelle E Nogalski | Physical Therapy | Prorehab PC | 107 Concord Plaza Shopping Ctr, Saint Louis, MO 63128-1307 |
| Yvonne M Layugan | Family Medicine | 123 Concord Plaza Shopping Ctr, Saint Louis, MO 63128-1307 | |
| Megan R Anna | Physical Therapy | Prorehab PC | 107 Concord Plaza Shopping Ctr, Saint Louis, MO 63128-1307 |
| Christopher J Tabor | Physical Therapy | The Physical Therapy Center, Inc. | 12048 Tesson Ferry Rd, Saint Louis, MO 63128-1727 |
| Find all physicians in zip 63128 | |||
| City | SAINT LOUIS |
| Zip Code | 63128 |
| Specialty | GENERAL SURGERY |
| City + Specialty | SAINT LOUIS + GENERAL SURGERY |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.