DR. ANDREA SHAE OTTO (NPI# 1851336325) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851336325 |
| Entity Type | Individual |
| Full Name | DR. ANDREA SHAE OTTO |
| Other Name | DR. ANDREA SHAE HEROLD |
| Credential | M.D. |
| Practice Address |
1001 S Kirkwood Rd Ste 300 Saint Louis MO 63122-7254 |
| Practice Telephone | 3145435943 |
| Practice Fax Number | 3145435953 |
| Mailing Telephone | 3145435943 |
| Mailing Fax Number | 3145435953 |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2017-03-14 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 2012013484 | MO | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | 23567 | NE | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NE | STATE LICENSE NUMBER | 23567 | 01 |
| MO | STATE LICENSE | 2012013484 | 01 |
| Street Address |
1001 S KIRKWOOD RD STE 300 |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63122-7254 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679570808 | Leonard F Fagan | Internal Medicine | 1001 S Kirkwood Rd, Suite 100, Saint Louis, MO 63122-7254 | 2005-07-01 |
| 1649747437 | Katherine Natalie Benjamin | Occupational Therapy Assistant | 1001 S Kirkwood Rd, Saint Louis, MO 63122-7254 | 2018-10-30 |
| 1578917464 | St. Anthony's Physician Organization | Internal Medicine | 1001 S Kirkwood Rd, Ste 300, Saint Louis, MO 63122-7254 | 2016-04-18 |
| 1740678226 | Brandy Hughes | Nurse Practitioner | 1001 S Kirkwood Rd, Saint Louis, MO 63122-7254 | 2015-01-06 |
| 1508205543 | Dermond Cortez Henry | Family Medicine | 1001 S Kirkwood Rd, Ste 300, Saint Louis, MO 63122-7254 | 2013-06-24 |
| 1215202510 | Joseph Jason Grassino | Physician Assistant | 1001 S Kirkwood Rd, Suite 120, Saint Louis, MO 63122-7254 | 2012-03-20 |
| 1255615951 | Rachel Ann Cook | Nurse Practitioner | 1001 S Kirkwood Rd, Saint Louis, MO 63122-7254 | 2011-09-29 |
| 1851553598 | St. Anthony's Physician Organization | Family Medicine | 1001 S Kirkwood Rd, Ste 300, Saint Louis, MO 63122-7254 | 2008-06-25 |
| 1992983662 | Corey Randall Rentfrow | Physician Assistant | 1001 S Kirkwood Rd, Saint Louis, MO 63122-7254 | 2008-02-05 |
| 1578761706 | Lubbna Johar | Family Medicine | 1001 S Kirkwood Rd, Ste 300, Saint Louis, MO 63122-7254 | 2007-07-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659933174 | Keela Rushing | Physical Therapist | 439 S Kirkwood Rd Ste 200, Kirkwood, MO 63122 | 2019-07-04 |
| 1730643461 | Kirkwood Family Dental | Dentist | 333 S Kirkwood Road, Suite 105, Kirkwood, MO 63122 | 2019-01-28 |
| 1477061166 | Total Access Urgent Care, PC | Clinic/Center | 2980 Dougherty Ferry Rd, Saint Louis, MO 63122 | 2018-01-16 |
| 1760933469 | Missouri Cvs Pharmacy, L.l.c | Durable Medical Equipment & Medical Supplies | 10820 Manchester Rd, Kirkwood, MO 63122 | 2016-10-18 |
| 1518321041 | M. Kathleen Blanchard | Counselor | 11042 Manchester Rd., Kirkwood, MO 63122 | 2016-04-11 |
| 1265801914 | Kim Grega | Counselor | 700 S Kirkwood Rd, Kirkwood, MO 63122 | 2015-09-23 |
| 1245617943 | Mark Edward Taylor | Dentist | 610 North Geyer, Kirkwood, MO 63122 | 2015-05-01 |
| 1467843094 | Mary Elizabeth Boomgarden | Physical Therapist | 9645 Big Bend Boulevard, Saint Louis, MO 63122 | 2015-02-18 |
| 1760725717 | Michael Diller Counseling | Counselor | 144 W Madison Avenue, Kirkwood, MO 63122 | 2013-03-28 |
| 1427309954 | Anne Marie Delaplain | Dentist | 725 Laclede Station Road, Webster Groves, MO 63122 | 2012-09-24 |
| Find all providers in zip 63122 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
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|---|---|---|---|---|
| 1356986541 | Pain Relief Center of St Louis LLC | Family Medicine | 1115 Olivette Executive Pkwy, Saint Louis, MO 63132-3259 | 2019-11-12 |
| 1720635329 | Mercy Clinic East Communities | Family Medicine | 10004 Kennerly Rd Ste 395b, Saint Louis, MO 63128-2190 | 2019-08-20 |
| 1063066777 | Isabella Citizens for Health, Inc. | Family Medicine | 312 Union St, Saint Louis, MI 48880-1830 | 2019-07-31 |
| 1043864010 | Isabella Citizens for Health, Inc. | Family Medicine | 113 E Saginaw St, Saint Louis, MI 48880-1755 | 2019-07-29 |
| 1558896969 | Shivani Sockanathan | Family Medicine | 969 N Mason Rd Ste 145a, Saint Louis, MO 63141-6282 | 2017-04-23 |
| 1598299646 | Kharole Compere | Family Medicine | 175 N Oaks Plz, Saint Louis, MO 63121-2925 | 2017-04-16 |
| 1396109880 | Ritesh Gandhi | Family Medicine | 7345 Watson Rd Ste 203, Saint Louis, MO 63119 | 2016-04-11 |
| 1144608035 | Daniel Urcuyo | Family Medicine | 4625 Lindell Blvd Ste 338, Saint Louis, MO 63108 | 2015-05-11 |
| 1376958728 | Jamil Neme | Family Medicine | 3660 Vista Ave Ste 103, Saint Louis, MO 63110-2540 | 2014-06-24 |
| 1144633819 | Perini Shah | Family Medicine | 12700 Southfork Rd Ste 215, Saint Louis, MO 63128-3276 | 2014-06-10 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63122 |
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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.