MEDICARE: JASON B AMATO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	112774	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	070015818	OTHER	MO	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	457893	OTHER	MO	HEALTHLINK
2	143496	OTHER	MO	BLUE CROSS BLUE SHIELD
3	7111216	OTHER	MO	AETNA

General Provider Information

NPI Number	:	1609832476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON B AMATO M.D.

Provider Business Mailing Address
First Line	:	522 N NEW BALLAS RD
Second Line	:	STE 203
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-6819
Country	:	US
Telephone Number	:	314-569-3323
Fax Number	:	314-569-3358

Provider Business Practice Location Address
First Line	:	522 N NEW BALLAS RD
Second Line	:	STE 203
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-6819
Country	:	US
Telephone Number	:	314-569-3323
Fax Number	:	314-569-3358

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	07/30/2019

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Directions to “ JASON B AMATO M.D.” Practice Location

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