State of Missouri
NPI 1710931167ActiveOrganization· Physical Medicine & Rehabilitation· Saint Louis, MO
Physical Medicine & Rehabilitation in Saint Louis, Missouri, registered in NPPES in May 2006, part of State of Missouri. The authorized official on file is Molly Jane Boeckmann, Director Of Administrative Services. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1710931167 |
|---|---|
| Status | Active |
| Entity type | Organization (subpart) |
| Parent organization | State of Missouri |
| NPI issued | May 20, 2006 |
| Last updated in NPPES | Oct 27, 2020 |
| Certified by provider | Oct 27, 2020 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physical Medicine & Rehabilitation Primary | 208100000X | — | — |
| Family Medicine | 207Q00000X | — | — |
| Psychiatry & Neurology, Psychiatry | 2084P0800X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (MO) |
|---|
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