Pediatric Orthotic and Prosthetic Services - Northwest, LLC

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

PEDIATRIC ORTHOTIC AND PROSTHETIC SERVICES - NORTHWEST, LLC

Practice address

4400 Clayton Ave
Saint Louis, MO 63110-1624

Phone

(314) 872-7891

NPI assigned

Sep 22, 2014

Organization subpart

Yes

Parent organization

PEDIATRIC ORTHOTIC AND PROSTHETIC SERVICES - NORTHWEST, LLCAs reported in NPPES

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

Authorized official

Name

Darren Rottmann, BOCP, CPOA

Title

Manager

Phone

(314) 872-7891

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Pediatric Orthotic and Prosthetic Services - Northwest, LLC

  • Durable Medical Equipment & Medical Supplies
  • Spokane, WA
  • NPI 1053719633

  9234388588

  Same PAC ID
• Pediatric Orthotic and Prosthetic Services - Northwest, LLC

  • Prosthetic/Orthotic Supplier
  • Portland, OR
  • NPI 1851669584

  9234388588

  Same PAC ID

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Tax ID family

Pediatric Orthotic and Prosthetic Services - Northwest LLC3 organizations share this tax ID, including this one

Part of

Pediatric Orthotic and Prosthetic Services - Northwest LLC

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Pediatric Orthotic and Prosthetic Services - Northwest, LLC

  • Durable Medical Equipment & Medical Supplies
  • Spokane, WA
  • NPI 1053719633
  NPD tax ID
• Pediatric Orthotic and Prosthetic Services - Northwest, LLC

  • Prosthetic/Orthotic Supplier
  • Portland, OR
  • NPI 1851669584
  NPD tax ID

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Shriners Hospitals for Children

  • Children's Hospital
  • Honolulu, HI
  • NPI 1316065360

  Member Of

  NPD member

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Leslie Douglas Stewart, MD

  • Surgery Physician
  • Memphis, TN
  • NPI 1902874282
  NPD (past)

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

{
    "created_epoch": "1411344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745366400000",
    "number": "1275935207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 947109",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303947109",
            "telephone_number": "813-367-2876",
            "fax_number": "813-518-7659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4400 CLAYTON AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101624",
            "telephone_number": "314-872-7891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC ORTHOTIC AND PROSTHETIC SERVICES - NORTHWEST, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PEDIATRIC ORTHOTIC AND PROSTHETIC SERVICES - NORTHWEST, LLC",
        "enumeration_date": "2014-09-22",
        "last_updated": "2025-04-23",
        "certification_date": "2025-04-23",
        "status": "A",
        "authorized_official_last_name": "ROTTMANN",
        "authorized_official_first_name": "DARREN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "314-872-7891",
        "authorized_official_credential": "BOCP, CPOA"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "MO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blake Edwin Pedersen, D.O.
• Peder Pedersen
• Rebecca Pederson
• Pediatric Behavior Specialists, LLC
• Pediatric Care for Kids
• Pediatric Urology Specialists, PC
• Pediatrix Medical Group
• Pediatrix Medical Group
• Pediatrix Medical Group of Missouri, P.C.
• Pedirite Medical Mo LLC

• Prosthetic/Orthotic Supplier in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Prosthetic/Orthotic Supplier in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2025; 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.