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DANIEL ZACKARY SOUVANNARATH
NPI 1174144828
Physician Assistant in Bridgeton, MO

Active since May 05, 2020PECOS Enrolled
12266 DE PAUL DR STE 310, BRIDGETON, MO 63044(314) 209-5171 Get Directions Write a Review

NPPES record last updated: September 13, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Sep 13, 2021, May 5, 2020 (2 updates tracked since 2020).

About Daniel Zackary Souvannarath NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DANIEL ZACKARY SOUVANNARATH (NPI 1174144828) is an individual physician assistant in Bridgeton, Missouri, licensed in Missouri (2021010216) and active in the NPI registry since May 2020. He is enrolled in Medicare PECOS and maintains a secondary practice location in Saint Louis.

NPPES Registry Identity

NPI1174144828
Entity TypeIndividualMale
Primary Taxonomy363A00000X
Provider Legal NameDANIEL ZACKARY SOUVANNARATH
Location Address12266 DE PAUL DR STE 310Bridgeton, MO 63044-2562
Mailing AddressPo Box 955534Saint Louis, MO 63195-5534
Phone(314) 209-5171
Sole ProprietorNo
Enumeration DateMay 5, 2020
Last NPPES UpdateSeptember 13, 20212 updates tracked since enumeration
NPPES CertifiedSeptember 13, 2021
✔ NPI 1174144828 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in MO · 2021010216
Definition
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.
12266 DE PAUL DR STE 310, Bridgeton, MO 63044
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Secondary Practice Location 1

Location 13437 Caroline St Ste 3082Saint Louis, MO 63104-1111 · Phone (314) 977-8648

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Daniel Zackary Souvannarath is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 63044 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$86.32 typical visit price
range $55.65 – $169.38
Typical copayment $21.58 (range $13.91 – $42.34)
Most-billed visit code 99203
Established Patient
$69.50 typical visit price
range $17.76 – $137.92
Typical copayment $17.37 (range $4.44 – $34.48)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ANDREA BAXTER MD
Family Medicine
12266 DE PAUL DR STE 310
BRIDGETON, MO 63044
St. Louis County (314) 344-6900

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Daniel Souvannarath's NPI number?

The NPI number for Daniel Souvannarath is 1174144828. It was assigned to this individual provider in the NPPES registry on May 5, 2020.

Where is Daniel Souvannarath located?

Daniel Souvannarath practices at 12266 De Paul Dr Ste 310, Bridgeton, MO 63044. The listed phone number is (314) 209-5171.

What is Daniel Souvannarath's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Daniel Souvannarath enrolled in Medicare?

Yes. Daniel Souvannarath is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Daniel Souvannarath was last updated on September 13, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.