Bluetail Medical Group, LLC.

Primary specialty

Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X

License

LC1262307 Issued in MO

Legal business name

BLUETAIL MEDICAL GROUP, LLC.

Practice address

13353 Olive Blvd
Chesterfield, MO 63017-3108

Phone

(636) 778-2900

Fax

(636) 778-2828

NPI assigned

Oct 12, 2012

Organization subpart

No

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

Authorized official

Name

Joe O'Neil

Title

Practice Administrator

Phone

(636) 778-2900

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 5

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

• David M Crane, MD

  • Sports Medicine (Emergency Medicine) Physician
  • Chesterfield, MO
  • NPI 1144291089
  Medicare reassignment Care Compare group NPD
• Christopher J Wolf, DO

  • Sports Medicine (Physical Medicine & Rehabilitation) Physician
  • Chesterfield, MO
  • NPI 1942240833
  Medicare reassignment Care Compare group NPD
• Raquel K Russo, PA-C

  • Physician Assistant
  • Chesterfield, MO
  • NPI 1013545607
  Medicare reassignment Care Compare group
• Robert R Hagan, MD

  • Plastic Surgery Physician
  • Saint Louis, MO
  • NPI 1558303511
  NPD (past)
• Paul Hobaica, MD

  • Internal Medicine Physician
  • Naples, FL
  • NPI 1730102609
  NPD (past)

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

{
    "created_epoch": "1350000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763337600000",
    "number": "1285986398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11665",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049154007",
            "telephone_number": "636-778-2900",
            "fax_number": "636-778-2828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13353 OLIVE BLVD",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630173108",
            "telephone_number": "636-778-2900",
            "fax_number": "636-778-2828"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "516 E State Road 32",
            "address_purpose": "LOCATION",
            "city": "Westfield",
            "state": "IN",
            "postal_code": "460748767",
            "country_code": "US",
            "telephone_number": "636-778-2900",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3852 Creamery Rd",
            "address_purpose": "LOCATION",
            "city": "DE Pere",
            "state": "WI",
            "postal_code": "541159210",
            "country_code": "US",
            "telephone_number": "636-778-2900",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2807 W Broadway Ste 107",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "MO",
            "postal_code": "652031317",
            "country_code": "US",
            "telephone_number": "636-778-2900",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "101 Hodencamp Rd Ste 102",
            "address_purpose": "LOCATION",
            "city": "Thousand Oaks",
            "state": "CA",
            "postal_code": "913605831",
            "country_code": "US",
            "telephone_number": "636-778-2900",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "36 Old Kings Hwy S Ste 105",
            "address_purpose": "LOCATION",
            "city": "Darien",
            "state": "CT",
            "postal_code": "068204523",
            "country_code": "US",
            "telephone_number": "636-778-2900",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1575 Lookout Dr",
            "address_purpose": "LOCATION",
            "city": "North Mankato",
            "state": "MN",
            "postal_code": "560032503",
            "country_code": "US",
            "telephone_number": "636-778-2900",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "160 Westmount Dr",
            "address_purpose": "LOCATION",
            "city": "Farmington",
            "state": "MO",
            "postal_code": "636402970",
            "country_code": "US",
            "telephone_number": "636-778-2900",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1875 Veterans Park Dr Ste 2201",
            "address_purpose": "LOCATION",
            "city": "Naples",
            "state": "FL",
            "postal_code": "341090596",
            "country_code": "US",
            "telephone_number": "239-631-1960",
            "fax_number": "239-631-5967",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BLUETAIL MEDICAL GROUP, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-12",
        "last_updated": "2025-11-17",
        "certification_date": "2025-11-17",
        "status": "A",
        "authorized_official_last_name": "O'NEIL",
        "authorized_official_first_name": "JOE",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "636-778-2900"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "MO",
            "license": "LC1262307",
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan Akers Blattel, MD
• Blink Health Pharmacy LLC
• Sarah Elizabeth Bloch, RN, MSN, FNP
• Amy Louise Bloomfield, PA
• Bluetail Biologics LLC
• Atrall Bobenhouse, M.A., CCC-SLP
• Evgenii Bobrikov, MD
• Leanne Marie Bockstruck, PHARM.D.
• Jeffrey L. Boesch, M.D.
• Michelle A Boettler, MD

• Sports Medicine (Orthopaedic Surgery) Physician in Chesterfield, MO
• Providers in Chesterfield, MO by specialty
• Sports Medicine (Orthopaedic Surgery) Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 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.