Active NPI 1407006364 Individual Practitioner Male Practitioner

Dr. Nicholas Adam Rudloff , DO

Dermatology • Riverside, MO

✓ Accepts Medicare Assignment

Public Directory Information & Medical Disclaimer

This profile is compiled from official public domain records provided by CMS and the NPPES registry. TRUE-MEDINFO is an independent reference directory and does not provide medical advice, diagnosis, or treatment recommendations. Always consult a licensed medical professional for personal health decisions.

Professional Overview & Biography Verified Profile Summary

Dr. Nicholas Rudloff, DO is a registered Dermatology practitioner in Riverside, MO. With approximately 15 years of clinical practice since completing medical education in 2011, Dr. Rudloff provides healthcare services at the registered practice location at 1805 NW PLATTE RD STE 120.

Dr. Rudloff is affiliated with Epiphany Dermatology Of Missouri Llc and accepts Medicare assignment.

Frequently performed procedures and clinical services include established patient outpatient office visit, destruction of precancer skin growth, 2-14 growths, tangential biopsy of single skin lesion. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

1805 Nw Platte Rd Ste 120

Riverside, MO 641507500

Telephone 8164720400

Medicare Profile & Education

Medical School

Other

Graduation Year

2011

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Dermatology in Riverside, MO

Established Specialist (10-20 Yrs)

Practitioner Clinical Experience

15 Yrs -6.7 yrs vs City Avg

City Avg: 21.7 Yrs

State Avg: 22.2 Yrs

Regional Practice Density

3 Specialists

Practicing in Riverside, MO (287 Statewide)

Telehealth Adoption Rate

0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

72.7% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Rudloff (15 Years) 15 Yrs

Riverside Specialty Average (21.7 Years) 21.7 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	845	544	$257.76	$83.03
17003 Destruction of precancer skin growth, 2-14 growths	763	136	$18.18	$5.85
11102 Tangential biopsy of single skin lesion	306	263	$276.42	$84.57
17000 Destruction of skin growth	253	200	$188.04	$47.67
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	149	149	$315.23	$102.17
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	132	110	$850.22	$246.06
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	102	90	$1884.38	$566.61
11103 Biopsy of related skin growth, each additional growth	95	71	$137.94	$44.31
17110 Destruction of up to 14 skin growths	87	80	$313.68	$99.34
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	85	77	$782.85	$126.96
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	61	48	$158.77	$51.20
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	55	41	$366.18	$117.99
17004 Destruction of precancer skin growth, 15 or more growths	38	28	$461.49	$148.51
12052 Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth	35	35	$880.18	$154.12
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	26	23	$1134.19	$363.77
12042 Intermediate repair of wound of neck, hands, feet, or genitals, 2.6-7.5 cm	23	23	$864.61	$175.01
17313 Removal and microscopic exam of growth of trunk, arms, or legs, 1-5 tissue blocks	22	20	$1795.09	$576.99
12051 Intermediate repair of wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less	22	20	$782.00	$166.10
11104 Punch biopsy, first skin growth	20	20	$340.77	$110.31
69100 Biopsy of ear	17	17	$258.67	$68.80
11403 Removal of noncancer skin growth of body, arms, or legs, 2.1-3.0 cm	16	16	$552.23	$88.65
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	12	12	$468.44	$144.62

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	839	551	$257.47	$85.96
17003 Destruction of precancer skin growth, 2-14 growths	557	97	$18.64	$6.23
11102 Tangential biopsy of single skin lesion	255	217	$284.31	$90.93
17000 Destruction of skin growth	195	155	$189.52	$53.07
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	154	154	$318.38	$106.42
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	108	97	$1912.44	$589.29
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	102	92	$859.70	$266.57
11103 Biopsy of related skin growth, each additional growth	65	48	$141.35	$47.23
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	64	12	$25.00	$1.07
17110 Destruction of up to 14 skin growths	63	62	$318.74	$102.57
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	61	56	$791.16	$136.55
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	38	36	$161.22	$53.94
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	37	25	$363.39	$121.44
12052 Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth	32	31	$898.06	$155.06
17004 Destruction of precancer skin growth, 15 or more growths	30	27	$464.85	$155.33
12042 Intermediate repair of wound of neck, hands, feet, or genitals, 2.6-7.5 cm	20	20	$877.79	$190.66
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	20	19	$1150.52	$385.24
12051 Intermediate repair of wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less	18	16	$794.58	$163.24
69100 Biopsy of ear	18	16	$273.39	$73.58
11403 Removal of noncancer skin growth of body, arms, or legs, 2.1-3.0 cm	17	17	$558.40	$93.25
11104 Punch biopsy, first skin growth	14	14	$351.44	$117.38

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	804	500	$260.45	$86.76
17003 Destruction of precancer skin growth, 2-14 growths	638	110	$18.94	$6.20
11102 Tangential biopsy of single skin lesion	234	203	$289.19	$92.91
17000 Destruction of skin growth	214	166	$190.83	$52.54
Q4180 Revita, per square centimeter	210	24	$760.41	$276.25
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	182	182	$321.18	$106.27
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	127	106	$869.13	$270.26
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	96	83	$1915.67	$625.07
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	89	73	$800.55	$134.01
11103 Biopsy of related skin growth, each additional growth	74	56	$144.09	$47.64
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	52	35	$160.86	$52.20
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	51	12	$22.45	$1.15
17110 Destruction of up to 14 skin growths	45	42	$318.68	$104.08
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	42	36	$366.34	$122.57
12052 Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth	41	37	$907.54	$156.13
12042 Intermediate repair of wound of neck, hands, feet, or genitals, 2.6-7.5 cm	27	25	$887.19	$219.93
11104 Punch biopsy, first skin growth	25	24	$354.02	$118.22
69100 Biopsy of ear	21	21	$275.26	$80.86
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	20	16	$1148.92	$385.57
15275 Application of skin substitute graft to wound of face, scalp, eyelids, mouth, neck, ears, around eyes, genitals, hands, feet, fingers, or toes, 25.0 sq cm or less of wound 100.0 sq cm or less	19	18	$458.97	$76.89
17313 Removal and microscopic exam of growth of trunk, arms, or legs, 1-5 tissue blocks	14	14	$1784.72	$597.39
17004 Destruction of precancer skin growth, 15 or more growths	14	12	$479.44	$160.07

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	839	542	$256.58	$87.97
17003 Destruction of precancer skin growth, 2-14 growths	593	114	$17.85	$6.06
17000 Destruction of skin growth	247	193	$182.88	$54.37
11102 Tangential biopsy of single skin lesion	245	220	$285.83	$96.68
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	223	223	$315.29	$107.84
Q4110 Primatrix, per square centimeter	122	11	$79.79	$42.22
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	100	86	$882.39	$265.19
11103 Biopsy of related skin growth, each additional growth	95	74	$147.03	$50.13
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	92	81	$1770.77	$629.17
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	66	47	$162.33	$54.77
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	60	52	$808.74	$142.07
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	55	13	$4.09	$1.26
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	50	35	$360.92	$125.63
17110 Destruction of up to 14 skin growths	39	36	$318.96	$107.13
12052 Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth	38	35	$895.25	$148.08
12042 Intermediate repair of wound of neck, hands, feet, or genitals, 2.6-7.5 cm	30	27	$885.16	$226.61
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	27	24	$1106.17	$384.72
11104 Punch biopsy, first skin growth	25	24	$352.64	$121.31
17313 Removal and microscopic exam of growth of trunk, arms, or legs, 1-5 tissue blocks	17	16	$1846.60	$623.27
15275 Application of skin substitute graft to wound of face, scalp, eyelids, mouth, neck, ears, around eyes, genitals, hands, feet, fingers, or toes, 25.0 sq cm or less of wound 100.0 sq cm or less	16	16	$465.88	$83.66
12051 Intermediate repair of wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less	16	16	$821.85	$180.60
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	15	15	$476.45	$165.02
69100 Biopsy of ear	13	13	$277.00	$78.80
11623 Removal of cancer skin growth of scalp, neck, hands, feet, or genitals, 2.1-3.0 cm	13	13	$865.95	$146.14

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	623	408	$128.97	$72.33
17003 Destruction of precancer skin growth, 2-14 growths	390	86	$15.77	$5.65
11102 Tangential biopsy of single skin lesion	190	176	$170.70	$92.30
17000 Destruction of skin growth	181	151	$111.69	$52.33
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	166	147	$188.21	$106.03
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	115	115	$185.70	$104.31
Q4110 Primatrix, per square centimeter	76	11	$84.98	$44.96
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	70	66	$526.80	$260.90
11103 Biopsy of related skin growth, each additional growth	59	47	$90.43	$50.58
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	48	46	$1156.71	$615.33
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	41	11	$6.41	$1.47
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	39	38	$489.92	$137.28
17110 Destruction of up to 14 skin growths	39	36	$190.61	$104.57
12052 Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth	21	21	$524.19	$154.08
11104 Punch biopsy, first skin growth	20	20	$213.81	$119.65
99202 New patient office or other outpatient visit, typically 20 minutes	16	16	$130.37	$72.90
12042 Intermediate repair of wound of neck, hands, feet, or genitals, 2.6-7.5 cm	13	13	$522.61	$226.21

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J7345 Aminolevulinic acid hcl for topical administration, 10% gel, 10 mg	3,600	12	$3.00	$1.40
99213 Established patient office or other outpatient visit, typically 15 minutes	750	462	$92.00	$73.41
17003 Destruction of precancer skin growth, 2-14 growths	676	111	$18.00	$5.62
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	339	281	$144.00	$107.67
11102 Tangential biopsy of single skin lesion	279	252	$197.00	$94.76
17000 Destruction of skin growth	258	192	$105.00	$54.56
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	249	249	$168.00	$107.27
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	184	33	$16.00	$1.61
11103 Biopsy of related skin growth, each additional growth	114	79	$110.00	$52.80
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	90	82	$425.00	$298.86
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	87	13	$80.00	$22.35
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	77	69	$1200.00	$593.47
17110 Destruction of up to 14 skin growths	49	47	$151.00	$106.46
11104 Punch biopsy, first skin growth	44	42	$248.00	$122.97
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	42	37	$357.00	$139.24
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	38	36	$323.00	$130.45
99202 New patient office or other outpatient visit, typically 20 minutes	32	32	$113.00	$73.22
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	32	31	$600.00	$262.69
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	28	25	$40.00	$16.49
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	23	20	$800.00	$394.72
69100 Biopsy of ear	20	19	$169.00	$85.59
96574 Application of light with debridement to destroy precancer skin growth	17	12	$500.00	$251.66
11105 Punch biopsy, each additional skin growth	17	14	$121.00	$60.50
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	13	13	$750.00	$281.46

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	676	409	$92.11	$71.36
17003 Destruction of precancer skin growth, 2-14 growths	626	111	$18.00	$5.21
11100 Biopsy of single growth of skin and/or tissue	308	284	$138.00	$101.20
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	298	298	$168.00	$106.13
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	296	235	$144.00	$105.69
17000 Destruction of skin growth	240	180	$105.00	$56.20
11101 Biopsy of each additional growth of skin and/or tissue	122	86	$51.00	$32.53
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	61	12	$16.00	$1.77
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	46	40	$1200.00	$579.66
17110 Destruction of up to 14 skin growths	43	41	$151.00	$109.83
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	33	32	$425.00	$290.57
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	25	23	$600.00	$245.36
69100 Biopsy of ear	24	23	$169.00	$80.76
99202 New patient office or other outpatient visit, typically 20 minutes	22	22	$113.00	$74.03
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	20	20	$357.00	$141.04
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	17	15	$800.00	$367.81
12042 Intermediate repair of wound of neck, hands, feet, or genitals, 2.6-7.5 cm	12	12	$395.00	$265.76
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	12	12	$323.00	$123.06

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	565	97	$17.91	$5.39
99213 Established patient office or other outpatient visit, typically 15 minutes	561	364	$92.00	$70.50
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	300	300	$168.00	$103.93
11100 Biopsy of single growth of skin and/or tissue	290	263	$138.00	$97.89
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	263	206	$144.00	$104.48
17000 Destruction of skin growth	201	149	$105.00	$53.57
11101 Biopsy of each additional growth of skin and/or tissue	96	79	$51.00	$32.12
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	74	18	$16.00	$1.79
17110 Destruction of up to 14 skin growths	52	42	$151.00	$104.96
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	39	38	$425.00	$294.05
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	32	18	$80.00	$19.61
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	30	27	$1200.00	$573.27
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	25	23	$323.00	$135.43
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	22	17	$431.82	$324.38
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	19	16	$357.00	$138.65
96567 Application of light and light-sensitive drugs to aid destruction of premalignant skin growths, per session	19	17	$175.00	$129.62
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	13	12	$800.00	$380.00
99202 New patient office or other outpatient visit, typically 20 minutes	13	13	$113.00	$73.11
13131 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 1.1-2.5 cm	12	11	$600.00	$204.64

Medical Specialties & State Licenses

CMS Verified: 2021-02-18

Dermatology Primary Specialty

NUCC Taxonomy Code: 207N00000X

State License MO 2014025262

A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.

Hospital & Practice Group Affiliations

Epiphany Dermatology Of Missouri Llc

1805 Nw Platte Rd, Riverside, MO 641507500

Phone: 8162058120

Practice Associates & Co-Workers

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

4 Associated Practitioners

Lynn Swafford

Physician Assistant

NPI 1174918445

Dr. Molly Menser , DO

Dermatology

NPI 1306049010

Doctor of Osteopathic Medicine (D.O.)

Dr. Jennifer Ashby , MD

Dermatology

NPI 1942245444

Doctor of Medicine (M.D.)

Dr. Brian Matthys , DO

Dermatology

NPI 1982631172

Doctor of Osteopathic Medicine (D.O.)

Career & Practice History Timeline

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

7 Historical Events

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) February 18, 2021

Dermatology (License #2014025262 in MO)

✅

NPI Profile Active March 02, 2015

NPI status registered as active in NPPES database

📍

Updated Practice Location March 02, 2015

Registered at 1805 NW PLATTE RD STE 120, RIVERSIDE, MO 641507500 (Tel: 8164720400)

📍

Updated Business Mailing Address March 02, 2015

Registered at 1805 NW PLATTE RD STE 120, RIVERSIDE, MO 641507500 (Tel: 8164720400)

👤

Provider Name / Credentials Updated March 02, 2015

Recorded as NICHOLAS RUDLOFF, D.O.

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) March 02, 2015

Student in an Organized Health Care Education/Training Program

🟢

Initial NPI Registration & Enumeration September 26, 2008

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: 1407006364

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: September 26, 2008

Last Update: February 18, 2021

Sole Proprietor: Yes

Update or Correct Profile

Mailing Address

1805 Nw Platte Rd Ste 120

Riverside, MO 641507500

Phone: 8164720400

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.