NPIMap

Individual provider Active NPI

Kyle Anthony O'Blanc, MD

  • Diagnostic Radiology Physician
  • Saint Louis, MO
National Provider Identifier
1013116458
Registry record updated Nov 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
2018014429 Issued in MO
Practice address
1825 High Oak Rd
Saint Louis, MO 63131-1501
Phone
(504) 710-8234
NPI assigned
Jul 16, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 15, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 2018014429 MO Primary

Addresses

Primary practice location

1825 High Oak Rd
Saint Louis, MO 63131-1501

Mailing address

1825 High Oak Rd
Saint Louis, MO 63131-1501
Phone (504) 710-8234

Other identifiers 2

IdentifierTypeStateIssuer
200062980MedicaidMO
ENROLLEDMedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190501001512 MO Practitioner - Diagnostic Radiology 9537258918 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Louisiana State University School of Medicine in New Orleans, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SSM Health Care St LouisGroup PAC ID 7810800737, 171 clinicians

Practice addresses (Care Compare)

12303 Depaul Dr
SSM Health Depaul Hospital Physician Billin
Bridgeton, MO 63044-2512
Phone (314) 344-6000

Hospital & facility affiliations

  • SSM Health St Mary'S Hospital - St Louis Hospital, Saint Louis, MO, CCN 260091
  • SSM St Clare Health Center Hospital, Fenton, MO, CCN 260081
  • SSM Health Depaul Hospital St Louis Hospital, Bridgeton, MO, CCN 260104
  • Mercy Hospital South Hospital, Saint Louis, MO, CCN 260077

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse, Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
SSM Health Care St. Louis CurrentSince Nov 15, 2021 Accepting new patients
Washington University Diagnostic Radiology CurrentSince Jun 15, 2019 Accepting new patients
SSM Health Care St Louis CurrentSince Nov 15, 2021 Accepting new patients
Miracl, LLC CurrentSince Jun 15, 2019 Accepting new patients

Locations

7344 Solutions Ctr
Chicago, IL 60677
Phone (314) 989-6189

1015 Bowles Ave
Fenton, MO 63026
Phone (636) 496-2000

1000 W 10th St
Rolla, MO 65401
Phone (573) 364-9000

1145 Corporate Lake Dr
Saint Louis, MO 63132
Phone (314) 989-6189

660 S Euclid Ave
#8131
Saint Louis, MO 63110
Phone (314) 362-2809

615 S New Ballas Rd
Saint Louis, MO 63141
Phone (314) 251-4687

510 S Kingshighway Blvd
Saint Louis, MO 63110
Phone (314) 362-0177

Organizations & group practices 17

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 17

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1184544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636934400000",
    "number": "1013116458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1825 HIGH OAK RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631311501",
            "telephone_number": "504-710-8234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1825 HIGH OAK RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631311501",
            "telephone_number": "504-710-8234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'BLANC",
        "first_name": "KYLE",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-07-16",
        "last_updated": "2021-11-15",
        "certification_date": "2021-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MO",
            "license": "2018014429",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200062980",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ENROLLED",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.