Individual provider Active NPI

Thomas Joseph Cunningham, OD

  • Optometrist
  • Chesterfield, MO
National Provider Identifier
1053427104
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
TO2856 Issued in MO
Practice address
92 Chesterfield Mall
Chesterfield, MO 63017-4808
Phone
(636) 530-0202
NPI assigned
Aug 22, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X TO2856 MO Primary

Addresses

Primary practice location

92 Chesterfield Mall
Chesterfield, MO 63017-4808

Mailing address

2183 Terrimill Ter
Chesterfield, MO 63017-7525
Phone (314) 397-5125

Medicare participation

Medicare enrollment files
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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101004000881 MO Practitioner - Optometry 0547452948 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of Missouri St Louis - School of Optometry, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pec Chesterfield LLCGroup PAC ID 7113330275, 2 clinicians
Pec St Peters LLCGroup PAC ID 7911266721, 3 clinicians

Practice addresses (Care Compare)

317 Clarkson Rd
Suite 102
Ellisville, MO 63011-2271
Phone (636) 725-2020

6043 Mid Rivers Mall Dr
Saint Peters, MO 63304-1108
Phone (636) 397-2020

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery13

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
TO2856MOMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Pec St Peters LLC Optometrist CurrentSince Aug 25, 2020 Accepting new patients
Pec Chesterfield, LLC Optometrist CurrentSince Sep 11, 2020 Accepting new patients

Locations

4111 N Illinois St
Swansea, IL 62226
Phone (314) 983-9800

317 Clarkson Rd
Ste 102
Ellisville, MO 63011
Phone (636) 391-3937

6043 Mid Rivers Mall Dr
Saint Peters, MO 63304
Phone (636) 397-2020

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1053427104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2183 TERRIMILL TER",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630177525",
            "telephone_number": "314-397-5125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "92 CHESTERFIELD MALL",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630174808",
            "telephone_number": "636-530-0202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUNNINGHAM",
        "first_name": "THOMAS",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "TO2856",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chesterfield, MO

Sources for this page

Verify at the official NPI Registry.