Individual provider Active NPI

Tamra A Nobbe, D.C.

  • Chiropractor
  • O Fallon, MO
National Provider Identifier
1174633481
Registry record updated Mar 3, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CE05026 Issued in MO
Practice address
110 E Pitman St
O Fallon, MO 63366-2619
Phone
(636) 272-4625
Fax
(636) 240-3522
NPI assigned
Aug 30, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 3, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CE05026 MO Primary

Addresses

Primary practice location

110 E Pitman St
O Fallon, MO 63366-2619

Mailing address

110 E Pitman St
O Fallon, MO 63366-2619
Phone (636) 272-4625

Other identifiers 4

IdentifierTypeStateIssuer
44-00212OtherMOUHC
110526OtherMOHEALTHLINK
4456568OtherMOAETNA
11152OtherMOBC/BS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101122000319 MO Practitioner - Chiropractic 1254527815

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CE05026MOMDChiropractor
005026MOMDMechanotherapist

Practice roles

OrganizationSpecialtyStatusNew patients
Ofallon Chiropractic & Acupuncture LLC Chiropractor CurrentSince Oct 21, 2005 Accepting new patients

Locations

110 E Pitman St
O Fallon, MO 63366
Phone (636) 272-4625

110 E Pitman St
#187
O Fallon, MO 63366
Phone (636) 272-4625

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": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1236038400000",
    "number": "1174633481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 E PITMAN ST",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633662619",
            "telephone_number": "636-272-4625",
            "fax_number": "636-240-3522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 E PITMAN ST",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633662619",
            "telephone_number": "636-272-4625",
            "fax_number": "636-240-3522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOBBE",
        "first_name": "TAMRA",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2009-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MO",
            "license": "CE05026",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC",
            "identifier": "44-00212",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "110526",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4456568",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "11152",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in O Fallon, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2009; 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.