Active NPI
Walton Sumner II, MD
- Family Medicine Physician
- Saint Louis, MO
National Provider Identifier
1265458483
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 110350
- Practice address
- 4950 Childrens PL
Saint Louis, MO 63110-1000 - Phone
- (314) 362-8164
- Fax
- (314) 362-6959
- NPI assigned
- Jul 14, 2006
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 110350 | MO | Primary |
Addresses
Primary practice location
4950 Childrens PL
Saint Louis, MO 63110-1000
Mailing address
660 S Euclid Ave
C B 8005
Saint Louis, MO 63110-1010
Phone (314) 362-8164
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 208564708 | Medicaid | MO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 110350 | MO | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152835200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1479081600000",
"number": "1265458483",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "660 S EUCLID AVE",
"address_2": "C B 8005",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631101010",
"telephone_number": "314-362-8164",
"fax_number": "314-362-6959"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4950 CHILDRENS PL",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631101000",
"telephone_number": "314-362-8164",
"fax_number": "314-362-6959"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUMNER",
"first_name": "WALTON",
"name_prefix": "Dr.",
"name_suffix": "II",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-14",
"last_updated": "2016-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MO",
"license": "110350",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "208564708",
"state": "MO"
}
],
"endpoints": [],
"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 Nov 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.