Fredericktown Primary Care – Family Medicine Physician, NPI 1063517613

Fredericktown Primary Care is a healthcare provider. based in Saint louis, Missouri. specializing in Family Medicine Physician. The organization holds a License No. ========= (MO). The NPI Number for Fredericktown Primary Care is 1063517613

Main info

Organization
Name
Fredericktown Primary Care
NPI
1063517613
Phone
(573) 783-4683
Address
PO BOX 504354
Authorized Official
MICHAEL PORTACCI PRESIDENT
Enumeration Date
14 September 2006
Last Update Date
21 July 2022
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience57
Completeness80
Years active:19State licenses:1Digital endpointsUpdated within 12 months

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Provider Addresses for Fredericktown Primary Care

  • PO BOX 504354

    SAINT LOUIS, MO 631500001

    Phone: (573) 783-4683

    Fax: (573) 783-4684

    Type: Mailing

  • Garrett Drive, Fredericktown, Madison County, Missouri, 63645, United States

    FREDERICKTOWN, MO 636451084

    Phone: (573) 783-4683

    Fax: (573) 783-4684

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

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.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 63150)

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Reviews

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Frequently asked questions

How do payers reference Fredericktown Primary Care?
For Fredericktown Primary Care, use NPI 1063517613 as the unique 10-digit identifier.
Active or inactive — what applies to Fredericktown Primary Care?
You should see Fredericktown Primary Care as active in CMS-hosted NPPES data.
What area of care is associated with Fredericktown Primary Care?
Fredericktown Primary Care's record emphasizes Family Medicine Physician. Clinical services aligned with this taxonomy classification.
Is Fredericktown Primary Care located near Saint Louis?
Fredericktown Primary Care currently maps to Saint Louis, Missouri in this extract.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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