Individual provider Active NPI

Bradley Carl Witbrodt, M.D.

  • Cardiovascular Disease Physician
  • Saint Louis, MO
National Provider Identifier
1275899718
Registry record updated Mar 31, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
2019014723 Issued in MO
Practice address
3023 N Ballas Rd Ste 200
Saint Louis, MO 63131-2330
Phone
(314) 996-7272
Fax
(314) 996-6785
NPI assigned
Apr 10, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 2019014723 MO Primary

Addresses

Primary practice location

3023 N Ballas Rd Ste 200
Saint Louis, MO 63131-2330

Mailing address

3023 N Ballas Rd Ste 200
Saint Louis, MO 63131-2330
Phone (314) 996-7272

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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 1

Enrollment IDStateProvider typePAC IDDetails
I20190820001303 MO Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 8921300104 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physician Groups LCGroup PAC ID 3072421254, 526 clinicians

Practice addresses (Care Compare)

1110 Highlands Plaza Dr E
Saint Louis, MO 63110-1351
Phone (314) 273-0195

2630 Hwy K
O Fallon, MO 63368-6624
Phone (636) 240-5454

3015 N Ballas Rd
Saint Louis, MO 63131-2329
Phone (314) 996-5772

3023 N Ballas Rd
Suite 200D
Saint Louis, MO 63131-2328
Phone (314) 996-7272

Hospital & facility affiliations

  • Missouri Baptist Medical Center Hospital, Saint Louis, MO, CCN 260108
  • Missouri Baptist Sullivan Hospital Hospital, Sullivan, MO, CCN 261337
  • Barnes Jewish Hospital Hospital, Saint Louis, MO, CCN 260032
  • Memorial Hospital Hospital, Belleville, IL, CCN 140185
  • Barnes-Jewish West County Hospital Hospital, Creve Coeur, MO, CCN 260162

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Physician Groups LC Cardiovascular Disease CurrentSince Dec 4, 2019 Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

301 N Washington St
Ste 5
Farmington, MO 63640
Phone (573) 756-1744

2630 Highway K
O Fallon, MO 63368
Phone (636) 240-5454

3023 N Ballas Rd
Ste 200
Saint Louis, MO 63131
Phone (314) 996-7272

3023 N Ballas Rd
Ste 200D
Saint Louis, MO 63131
Phone (314) 996-7272

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

Interoperability endpoints

  • Direct secure messaging: bwitbrodt242551@direct.carenet.org

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 and National Provider Directory roles.

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": "1334016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617148800000",
    "number": "1275899718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3023 N BALLAS RD STE 200",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631312330",
            "telephone_number": "314-996-7272",
            "fax_number": "314-996-6785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3023 N BALLAS RD STE 200",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631312330",
            "telephone_number": "314-996-7272",
            "fax_number": "314-996-6785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WITBRODT",
        "first_name": "BRADLEY",
        "middle_name": "CARL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-10",
        "last_updated": "2021-03-31",
        "certification_date": "2021-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MO",
            "license": "2019014723",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3023 N Ballas Rd Ste 200",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631312330",
            "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.