Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mariah Boncek, PA-C

Individual provider Physician Assistant · NPI 1649808247

Mariah Boncek, PA-C is a Physician Assistant in Saint Louis, Missouri. Qualified in 2020, 6 years ago. Registered with an NPI since 2020.

Years since qualifying
6
In the registry since
2020
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

1430 Olive St Ste 100
Saint Louis, MO 63103-2303
Phone: (314) 645-6840
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1649808247
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedMarch 30, 2020
Last updated in NPPESMay 17, 2021
Certification dateMay 17, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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