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Deactivated NPI 1588778914 Deactivated / Inactive NPI Female Practitioner

Melissa Ann Koonce , MS, ATC

Specialist • Bridgeton, MO

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Melissa Koonce has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date August 19, 2006
NPI Deactivation Date May 03, 2023
Total Practice Duration ~17 Years of Practice (2006 – 2023)

Professional Overview & Biography Verified Profile Summary

Melissa Koonce, MS, ATC was a registered Specialist practicing in Bridgeton, MO. Throughout an active medical career spanning 17 years, Melissa Koonce provided care at the practice location at 12277 DE PAUL DR STE 305 until profile deactivation on 2023-05-03.

Practice Location & Contact Primary Location

Practice Address

12277 De Paul Dr Ste 305

Bridgeton, MO 630442529

Telephone 3142913399
Fax 3142913466
Associated Practice Facility / Clinic
🏢 Ssm Medical Group Inc. Facility NPI 1053616110

Specialty Benchmarks & Practice Insights

Comparative analytics for Specialist in Bridgeton, MO

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 37.3 Yrs
Regional Practice Density
6 Specialists

Practicing in Bridgeton, MO (503 Statewide)

Telehealth Adoption Rate
0.0% 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

Specialist Primary Specialty

NUCC Taxonomy Code: 174400000X

An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

Practice Associates & Co-Workers

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

2 Associated Practitioners
Paul Diesfeld , PA-C

Physician Assistant

NPI 1396796041

Physician Assistant (Certified)

NPI 1831124056

Doctor of Chiropractic

Career & Practice History Timeline

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

7 Historical Events
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NPI Profile Deactivated May 03, 2023

Record deactivated on May 03, 2023

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

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Updated Practice Location July 08, 2007

Registered at 12277 DE PAUL DR STE 305, BRIDGETON, MO 630442529 (Tel: 3142913399)

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Updated Business Mailing Address July 08, 2007

Registered at 505 LOUISA AVE, DUPO, IL 622391407 (Tel: 6182864154)

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Provider Name / Credentials Updated July 08, 2007

Recorded as MELISSA KOONCE, MS, ATC

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Specialist

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Initial NPI Registration & Enumeration August 19, 2006

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: 1588778914
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: August 19, 2006
Last Update: July 08, 2007
Deactivation Date: May 03, 2023

Mailing Address

505 Louisa Ave

Dupo, IL 622391407

Phone: 6182864154

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.