Individual provider Active NPI

William Carpenter, DC

  • Chiropractor
  • Fenton, MO
National Provider Identifier
1225407463
Registry record updated Feb 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2015032036 Issued in MO
Practice address
560 Old Smizer Mill Rd
Fenton, MO 63026-3538
Phone
(636) 492-1528
NPI assigned
Sep 17, 2015
Last updated
Feb 13, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 13, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 2015032036 MO Primary

Addresses

Primary practice location

560 Old Smizer Mill Rd
Fenton, MO 63026-3538

Mailing address

560 Old Smizer Mill Rd
Fenton, MO 63026-3538
Phone (636) 492-1528

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151030001162 MO Practitioner - Chiropractic 3971813114 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Logan College of Chiropractic, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Revival Chiropractic LLCGroup PAC ID 0547500993, 3 clinicians

Practice addresses (Care Compare)

560 Old Smizer Mill Rd
Fenton, MO 63026-3538
Phone (636) 492-1528

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Revival Chiropractic LLC Chiropractor CurrentSince Sep 4, 2018 Accepting new patients
Jacob Briegleb, LLC Chiropractor Past Accepting new patients

Locations

464 Old Smizer Mill Rd
Fenton, MO 63026
Phone (636) 492-1528

560 Old Smizer Mill Rd
Fenton, MO 63026
Phone (636) 492-1528

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1442448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707782400000",
    "number": "1225407463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "560 OLD SMIZER MILL RD",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630263538",
            "telephone_number": "636-492-1528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "560 OLD SMIZER MILL RD",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630263538",
            "telephone_number": "636-492-1528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARPENTER",
        "first_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-09-17",
        "last_updated": "2024-02-13",
        "certification_date": "2024-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MO",
            "license": "2015032036",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fenton, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.