NPIMap

Organization Active NPI

Hodag Medical Services, LLC

  • Otolaryngology/Facial Plastic Surgery Physician
  • Saint Peters, MO
National Provider Identifier
1003336819
Registry record updated Aug 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology/Facial Plastic Surgery PhysicianTaxonomy code 207YX0905X
License
R6G71 Issued in MO
Legal business name
HODAG MEDICAL SERVICES, LLC
Practice address
4800 Mexico Rd Ste 103
Saint Peters, MO 63376-1666
Phone
(636) 936-5002
Fax
(314) 821-5029
NPI assigned
Jun 22, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Paul E. Burk, DONPI 1790786838
Title
Physician
Phone
(314) 821-5002

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngic Allergy PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207YX0602X R6G71 MO
Otolaryngology/Facial Plastic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207YX0905X R6G71 MO Primary

Addresses

Primary practice location

4800 Mexico Rd Ste 103
Saint Peters, MO 63376-1666

Mailing address

1324 Clarkson Clayton Ctr Unit 301
Ellisville, MO 63011-2145
Phone (314) 541-6838

Other practice location 1

12277 De Paul Dr Ste 303
Bridgeton, MO 63044-2529
Phone (314) 770-0708

Other practice location 2

2315 Dougherty Ferry Rd Ste 103
Saint Louis, MO 63122-3383
Phone (314) 821-5002

Other identifiers 2

IdentifierTypeStateIssuer
242428308MedicaidMO
1790786838OtherNPI

National Provider Directory

National Provider Directory

Locations

12277 De Paul Dr
Ste 303
Bridgeton, MO 63044
Phone (314) 344-7575

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1498089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565654400000",
    "number": "1003336819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1324 CLARKSON CLAYTON CTR UNIT 301",
            "city": "ELLISVILLE",
            "state": "MO",
            "postal_code": "630112145",
            "telephone_number": "314-541-6838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 MEXICO RD STE 103",
            "city": "SAINT PETERS",
            "state": "MO",
            "postal_code": "633761666",
            "telephone_number": "636-936-5002",
            "fax_number": "314-821-5029"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12277 De Paul Dr Ste 303",
            "address_purpose": "LOCATION",
            "city": "Bridgeton",
            "state": "MO",
            "postal_code": "630442529",
            "country_code": "US",
            "telephone_number": "314-770-0708",
            "fax_number": "314-821-5029",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2315 Dougherty Ferry Rd Ste 103",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631223383",
            "country_code": "US",
            "telephone_number": "314-821-5002",
            "fax_number": "314-821-5029",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "HODAG MEDICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-22",
        "last_updated": "2019-08-13",
        "status": "A",
        "authorized_official_last_name": "BURK",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "314-821-5002",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207YX0602X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology, Otolaryngic Allergy",
            "state": "MO",
            "license": "R6G71",
            "primary": false
        },
        {
            "code": "207YX0905X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "MO",
            "license": "R6G71",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "242428308",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1790786838",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Peters, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.