Active NPI
Robert B Cusworth, MD
- Gastroenterology Physician
- Saint Peters, MO
National Provider Identifier
1255339560
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- R6241
- Practice address
- 201 BJC Saint Peters Dr
Suite 100
Saint Peters, MO 63376-3091 - Phone
- (636) 916-8200
- Fax
- (636) 947-4246
- NPI assigned
- Jul 11, 2005
- 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 |
|---|---|---|---|---|
| Gastroenterology Physician | 207RG0100X | R6241 | MO | Primary |
Addresses
Primary practice location
201 BJC Saint Peters Dr
Suite 100
Saint Peters, MO 63376-3091
Mailing address
201 BJC Saint Peters Dr
Suite 100
Saint Peters, MO 63376-3091
Phone (636) 916-8200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 201188919 | Medicaid | MO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121040000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1418601600000",
"number": "1255339560",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "201 BJC SAINT PETERS DR",
"address_2": "SUITE 100",
"city": "SAINT PETERS",
"state": "MO",
"postal_code": "633763091",
"telephone_number": "636-916-8200",
"fax_number": "636-947-4246"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 BJC SAINT PETERS DR",
"address_2": "SUITE 100",
"city": "SAINT PETERS",
"state": "MO",
"postal_code": "633763091",
"telephone_number": "636-916-8200",
"fax_number": "636-947-4246"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CUSWORTH",
"first_name": "ROBERT",
"middle_name": "B",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-11",
"last_updated": "2014-12-15",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "MO",
"license": "R6241",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "201188919",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Peters, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2014; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.