Lemuel Yia Sibulo Jr., D.O.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

2021047392 Issued in MO

Practice address

1402 S Grand Blvd
M260
Saint Louis, MO 63104-1004

Phone

(314) 977-9853

NPI assigned

Apr 4, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

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

Practice roles

Locations

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.

• Aim Anesthesia LLC

  • Anesthesiology Physician
  • Bridgetown, MO
  • NPI 1245685601
  Medicare reassignment NPD
• Orthomed Staffing LLC

  • Anesthesiology Physician
  • Addison, TX
  • NPI 1225514276

  MO

  Medicare reassignment NPD

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

{
    "created_epoch": "1491264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686614400000",
    "number": "1104359470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11361 CORSICA MIST AVE",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891351338",
            "telephone_number": "503-330-0389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1402 S GRAND BLVD",
            "address_2": "M260",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631041004",
            "telephone_number": "314-977-9853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIBULO",
        "first_name": "LEMUEL",
        "middle_name": "YIA",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-04",
        "last_updated": "2023-06-13",
        "certification_date": "2023-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MO",
            "license": "2021047392",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Timothy L Shurtleff, OT
• Corey Lamar Shy, MD
• Jaye M Shyken, MD
• Risa Shyres
• Cerise Marie Siamof, MD
• Hollie Sicking
• Lori Sickmann
• Hadi Faheem Siddique, MD
• Aziza N/a Siddiqui, MSW
• Fizzah Siddiqui

• Anesthesiology Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Anesthesiology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2023; 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.