Bridgeton Pain Group

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

BRIDGETON PAIN GROUP

Practice address

11520 Saint Charles Rock Rd Ste 201
Bridgeton, MO 63044

Phone

(314) 526-6093

NPI assigned

Feb 27, 2023

Organization subpart

No

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

Authorized official

Name

Mitchell Liberman

Title

President

Phone

(314) 526-6093

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Subrahmanyam Vadlamani, M.D.

  • General Practice Physician
  • Saint Louis, MO
  • NPI 1558355214
  Medicare reassignment NPD

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

{
    "created_epoch": "1677456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698624000000",
    "number": "1114626462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11520 SAINT CHARLES ROCK RD STE 201",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442732",
            "telephone_number": "314-526-6093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11520 SAINT CHARLES ROCK RD STE 201",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "63044",
            "telephone_number": "314-526-6093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGETON PAIN GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-27",
        "last_updated": "2023-10-30",
        "certification_date": "2023-10-30",
        "status": "A",
        "authorized_official_last_name": "LIBERMAN",
        "authorized_official_first_name": "MITCHELL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "314-526-6093"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bridgeton Emergency Group LLC
• Bridgeton Foot and Ankle LLC
• Bridgeton Geriatrics LLC
• Bridgeton Imaging, L.L.C.
• Bridgeton Operations, LLC
• Brielle Holly Bright, PT, DPT
• Brighten Your Day Home Health Care LLC.
• Robert Brinkman, M.D.
• Emily Terese Britt, DPT
• Lisa Cathleen Briz, LCSW

• General Practice Physician in Bridgeton, MO
• Providers in Bridgeton, MO by specialty
• General Practice Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.