Active NPI
Walter F Benoist, M.D.
- Pediatrics Physician
- Bridgeton, MO
National Provider Identifier
1164538880
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 34817
- Practice address
- 12277 De Paul Dr
Suite 506
Bridgeton, MO 63044-2516 - Phone
- (314) 770-2300
- Fax
- (314) 770-1843
- NPI assigned
- Aug 23, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 34817 | MO | Primary |
Addresses
Primary practice location
12277 De Paul Dr
Suite 506
Bridgeton, MO 63044-2516
Mailing address
12277 De Paul Dr
Suite 506
Bridgeton, MO 63044-2516
Phone (314) 770-2300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34817 | MO | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gateway Pediatrics, LTD | Pediatrics | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1164538880",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12277 DE PAUL DR",
"address_2": "SUITE 506",
"city": "BRIDGETON",
"state": "MO",
"postal_code": "630442516",
"telephone_number": "314-770-2300",
"fax_number": "314-770-1843"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12277 DE PAUL DR",
"address_2": "SUITE 506",
"city": "BRIDGETON",
"state": "MO",
"postal_code": "630442516",
"telephone_number": "314-770-2300",
"fax_number": "314-770-1843"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENOIST",
"first_name": "WALTER",
"middle_name": "F",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MO",
"license": "34817",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bridgeton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.