Active NPI
Brad C White, MD
- Urology Physician
- Saint Louis, MO
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- 114377
- 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, 2021
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 203832209 | Medicaid | MO |
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| 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, IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
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
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
- Missouri Baptist Medical Center
- Missouri Baptist Sullivan Hospital
- St Lukes Hospital
- Anderson Hospital
- Progress West Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Prostate resection | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-097383 | IL | MD | Urology Physician |
| 114377 | MO | MD | Urology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Urology of St. Louis, Inc. | Current | Accepting new patients | |
| Urology of St. Louis, Inc. | Urology | Current | Accepting new patients |
| Central PA Pharmacy LLC. | Current | Accepting new patients | |
| Ahs Il Medical Group LLC | Current | Accepting new patients | |
| Osf Multi-Specialty Group | Current | Accepting new patients | |
| Urology of St. Louis, Inc. | Urology | Past | Accepting new patients |
| Metropolitan Urological Specialists PC | Urology | Past | 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
- 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.
-
dba Neurosurgery of St Louis
- Specialist
- Saint Louis, MO
- NPI 1528017191
IL, Urology
-
- Clinic/Center
- Granite City, IL
- NPI 1659098101
-
- Internal Medicine Physician
- Peoria, IL
- NPI 1922445527
-
dba patton pharmacy and v&s variety
- Community/Retail Pharmacy
- Patton, PA
- NPI 1578541413
-
- Urology Physician
- Saint Louis, MO
- NPI 1578667051
-
- Urology Physician
- Fairview Heights, IL
- NPI 1528901287
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Critical Access Hospital
- Sullivan, MO
- NPI 1295743169
-
dba Missouri Baptist Sullivan Hospital
- Ambulance
- Sullivan, MO
- NPI 1831343268
Hospital
-
- General Acute Care Hospital
- Saint Louis, MO
- NPI 1487663506
-
- General Acute Care Hospital
- O'Fallon, MO
- NPI 1508938044
-
dba St. Luke's Hospital
- General Acute Care Hospital
- Chesterfield, MO
- NPI 1346251543
-
- General Acute Care Hospital
- Maryville, IL
- NPI 1053481630
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2021; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.