Unknown Individual – Emergency Medicine Physician, NPI 1730108101
Emergency Medicine Physician
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Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Unknown Individual
1333 S Sam Houston Blvd
Houston, MO 654832046
Phone: (417) 967-3311
Type: Location
1015 Bowles Ave
Fenton, MO 630262394
Phone: (636) 496-2100
Type: Location
1415 ELBRIDGE PAYNE RD STE 120
CHESTERFIELD, MO 630178522
Phone: (636) 728-1300
Fax: (636) 519-7965
Type: Mailing
1333 S SAM HOUSTON BLVD
HOUSTON, MO 654832046
Phone: (417) 967-3311
Type: Location
SSM St. Clare Health Center, 1015, Bowles Avenue, Fenton, Saint Louis County, Missouri, 63026, United States
FENTON, MO 630262394
Phone: (636) 496-2100
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99284 | Emergency department visit with moderate level of medical decision making | 160 | 156 | $0 |
| 99285 | Emergency department visit with high level of medical decision making | 144 | 137 | $0 |
| 99291 | Critical care, first 30-74 minutes | 34 | 34 | $0 |
| 99283 | Emergency department visit with low level of medical decision making | 21 | 21 | $0 |
Insurance plans in this area (ZIP 65483)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| EMERGENCY MEDICINE | MO | 93010 | Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report | 328 | 305 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | MO | |
| Nurse Practitioner | MO | |
| Nurse Practitioner | MO | |
| Physician Assistant | MO | |
| - | MO | |
| - | MO | |
| - | MO | |
| Nurse Practitioner | MO | |
| Nurse Practitioner | MO | |
| Family Practice | FL |
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