NPIMap

Organization Active NPI

St Clair Orthopedics, SC

  • Orthopaedic Surgery Physician
  • Swansea, IL
National Provider Identifier
1073541728
Registry record updated Oct 29, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
ST CLAIR ORTHOPEDICS, SC
Practice address
33 Bronze Pointe Blvd
Suite 100
Swansea, IL 62226-8311
Phone
(618) 257-1177
Fax
(618) 257-1184
NPI assigned
Jun 30, 2006
Last updated
Oct 29, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2010

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

Authorized official

Name
Mr. Chad Sackman
Title
Administrator
Phone
(314) 849-0311

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X NU Primary

Addresses

Primary practice location

33 Bronze Pointe Blvd
Suite 100
Swansea, IL 62226-8311

Mailing address

12639 Old Tesson Rd
Suite 115
Saint Louis, MO 63128-2786
Phone (314) 849-0311

Other identifiers 2

IdentifierTypeStateIssuer
263758OtherILGROUP HEALTHPLAN
761576OtherILAETNA

National Provider Directory

National Provider Directory

Locations

33 Bronze Pointe Blvd
Ste 100
Swansea, IL 62226
Phone (618) 257-1177

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288310400000",
    "number": "1073541728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12639 OLD TESSON RD",
            "address_2": "SUITE 115",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631282786",
            "telephone_number": "314-849-0311",
            "fax_number": "314-849-4423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 BRONZE POINTE BLVD",
            "address_2": "SUITE 100",
            "city": "SWANSEA",
            "state": "IL",
            "postal_code": "622268311",
            "telephone_number": "618-257-1177",
            "fax_number": "618-257-1184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST CLAIR ORTHOPEDICS, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-30",
        "last_updated": "2010-10-29",
        "status": "A",
        "authorized_official_last_name": "SACKMAN",
        "authorized_official_first_name": "CHAD",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "314-849-0311",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP HEALTHPLAN",
            "identifier": "263758",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "761576",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Swansea, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2010; 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.