Justin Pelkey, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

2024023265 Issued in MO

Practice address

12680 Olive Blvd Ste 300
Saint Louis, MO 63141-6322

Phone

(314) 251-8888

Fax

(314) 251-8889

NPI assigned

Apr 8, 2024

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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

{
    "created_epoch": "1712534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719360000000",
    "number": "1043063514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 S NEW BALLAS RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12680 OLIVE BLVD STE 300",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631416322",
            "telephone_number": "314-251-8888",
            "fax_number": "314-251-8889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PELKEY",
        "first_name": "JUSTIN",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-04-08",
        "last_updated": "2024-06-26",
        "certification_date": "2024-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2024023265",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Guido David Pelaez, MD
• Bonnie Lou Pelch, LCSW, MSSW, ACSW
• Julia Peled, M.D.
• Yvette Kristine Pelikan, LCSW
• Jeffrey T Pelizzaro, MPT
• Jonathan Adam Pellechia, PA-C
• Pellegrine Inc/Dba Pearle Vision
• Sophia Pellegrini
• Grace B Pelowski, APRN
• Ann Pelt, LMSW

• Family Medicine Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Family Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.