Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1174144828 Individual Practitioner Male Practitioner

Daniel Zackary Souvannarath

Physician Assistant • Bridgeton, MO

Professional Overview & Biography Verified Profile Summary

Daniel Souvannarath is a registered healthcare professional specializing in Physician Assistant in Bridgeton, MO. Practice services are available at 12266 DE PAUL DR STE 310 under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

12266 De Paul Dr Ste 310

Bridgeton, MO 630442562

Telephone 3142095171
Associated Practice Facility / Clinic
🏢 Ssm Medical Group, Inc. Facility NPI 1194736116

Specialty Benchmarks & Practice Insights

Comparative analytics for Physician Assistant in Bridgeton, MO

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 11.4 Yrs
State Avg: 10.3 Yrs
Regional Practice Density
20 Specialists

Practicing in Bridgeton, MO (1802 Statewide)

Telehealth Adoption Rate
5.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2021-09-13
Physician Assistant Primary Specialty

NUCC Taxonomy Code: 363A00000X

State License MO 2021010216

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Physician Assistant

NUCC Taxonomy Code: 363A00000X

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Secondary Practice Locations

3437 Caroline St Ste 3082

Saint Louis, MO 631041111

Phone: 3149778648

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

1 Associated Practitioners
Dr. Andrea Baxter , MD

Family Medicine

NPI 1518984053

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

9 Historical Events
📍
Updated Practice Location September 13, 2021

Registered at 12266 DE PAUL DR STE 310, BRIDGETON, MO 630442562 (Tel: 3142095171)

📍
Updated Business Mailing Address September 13, 2021

Registered at PO BOX 955534, SAINT LOUIS, MO 631955534

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) September 13, 2021

Physician Assistant (License #2021010216 in MO)

NPI Profile Active May 05, 2020

NPI status registered as active in NPPES database

📍
Updated Practice Location May 05, 2020

Registered at 3437 CAROLINE ST STE 3082, SAINT LOUIS, MO 631041111 (Tel: 3149778648)

📍
Updated Business Mailing Address May 05, 2020

Registered at 1810 VALLEY RIDGE DR, IMPERIAL, MO 630522266 (Tel: 3147759602)

👤
Provider Name / Credentials Updated May 05, 2020

Recorded as DANIEL SOUVANNARATH

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) May 05, 2020

Physician Assistant

🟢
Initial NPI Registration & Enumeration May 05, 2020

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1174144828
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: May 05, 2020
Last Update: September 13, 2021
Sole Proprietor: No

Mailing Address

Po Box 955534

Saint Louis, MO 631955534

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.