Individual provider Active NPI

Brad C White, MD

  • Urology Physician
  • Saint Louis, MO
National Provider Identifier
1205810512
Registry record updated Dec 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
114377 Issued in MO
Practice address
12855 N 40 Dr
Suite 375
Saint Louis, MO 63141-8635
Phone
(314) 567-6071
Fax
(314) 567-7961
NPI assigned
Nov 30, 2005
Last updated
Dec 1, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 036-097383 IL
Urology Physician 208800000X 114377 MO Primary

Addresses

Primary practice location

12855 N 40 Dr
Suite 375
Saint Louis, MO 63141-8635

Mailing address

12855 N 40 Dr
Suite 375
Saint Louis, MO 63141-8635
Phone (314) 567-6071

Other practice location 1

450 N New Ballas Rd Ste 150N
Saint Louis, MO 63141-6835
Phone (314) 315-9914

Other practice location 2

965 Mattox Dr
Sullivan, MO 63080-2365
Phone (573) 468-7054

Other identifiers 1

IdentifierTypeStateIssuer
203832209MedicaidMO

Electronic endpoints 2

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2 Health Information Exchange (HIE) Missouri Baptist Medical Center
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2 Health Information Exchange (HIE) Missouri Baptist Hospital of Sullivan

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, IL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20100118000270 MO Practitioner - Urology 8325935810 Reassigns benefits to 1 organization
I20101214000940 IL Practitioner - Urology 8325935810 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Loyola University of Chicago, Stritch School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Urology of St Louis IncGroup PAC ID 6204723786, 112 clinicians

Practice addresses (Care Compare)

12855 N 40 Dr
Suite 375
Saint Louis, MO 63141-8657
Phone (314) 567-6071

6812 State Route 162 200
Maryville, IL 62062-8562
Phone (618) 288-0900

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036-097383ILMDUrology Physician
114377MOMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Urology of St. Louis, Inc. CurrentSince Dec 2, 1997 Accepting new patients
Urology of St. Louis, Inc. Urology CurrentSince Dec 2, 1997 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Ahs Il Medical Group LLC CurrentSince Mar 1, 2023 Accepting new patients
Osf Multi-Specialty Group CurrentSince Jun 1, 2023 Accepting new patients
Urology of St. Louis, Inc. Urology Past Accepting new patients
Metropolitan Urological Specialists PC Urology PastSince Jan 1, 2005 Accepting new patients

Locations

1 Saint Anthonys Way
Alton, IL 62002
Phone (618) 233-6870

2 Memorial Dr
Ste 102
Alton, IL 62002
Phone (618) 288-0900

2 Saint Anthonys Way
Ste 300
Alton, IL 62002
Phone (618) 462-2226

2044 Madison Ave
Ste G7
Granite City, IL 62040
Phone (314) 500-2424

6812 State Route 162
Ste 200
Maryville, IL 62062
Phone (618) 288-0900

8 Doctors Park Rd
Mount Vernon, IL 62864
Phone (618) 244-5500

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

215 Dunn Rd
Florissant, MO 63031
Phone (314) 315-9911

20 Progress Point Pkwy
Ste 202
O Fallon, MO 63368
Phone (314) 993-6401

12855 N 40 Dr
Saint Louis, MO 63141
Phone (314) 432-4415

12855 N 40 Dr
Lowr
Saint Louis, MO 63141
Phone (618) 973-8740

12855 N 40 Dr
Ste 375
Saint Louis, MO 63141

12855 N 40 Dr
Ste Ll
Saint Louis, MO 63141

456 N New Ballas Rd
Ste 348
Saint Louis, MO 63141
Phone (314) 548-0265

965 Mattox Dr
Sullivan, MO 63080
Phone (573) 468-7054

Interoperability endpoints

  • Direct secure messaging: bradwhite@slus.allscriptsdirect.net

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1133308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638316800000",
    "number": "1205810512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12855 N 40 DR",
            "address_2": "SUITE 375",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418635",
            "telephone_number": "314-567-6071",
            "fax_number": "314-567-7961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12855 N 40 DR",
            "address_2": "SUITE 375",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418635",
            "telephone_number": "314-567-6071",
            "fax_number": "314-567-7961"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "450 N New Ballas Rd Ste 150N",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631416835",
            "country_code": "US",
            "telephone_number": "314-315-9914",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "965 Mattox Dr",
            "address_purpose": "LOCATION",
            "city": "Sullivan",
            "state": "MO",
            "postal_code": "630802365",
            "country_code": "US",
            "telephone_number": "573-468-7054",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WHITE",
        "first_name": "BRAD",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-30",
        "last_updated": "2021-12-01",
        "certification_date": "2021-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "IL",
            "license": "036-097383",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "MO",
            "license": "114377",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "203832209",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2",
            "affiliation": "Y",
            "endpointDescription": "bjc",
            "affiliationName": "Missouri Baptist Medical Center",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "12855 N 40 Dr",
            "address_2": "Suite 375",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631418635",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2",
            "affiliation": "Y",
            "endpointDescription": "bjc",
            "affiliationName": "Missouri Baptist Hospital of Sullivan",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "965 Mattox Dr",
            "city": "Sullivan",
            "state": "MO",
            "country_code": "US",
            "postal_code": "630802365",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.