NPIMap

Organization Active NPI

Brainworks Pediatric Group LLC

  • Speech-Language Pathologist
  • O Fallon, MO
National Provider Identifier
1306248794
Registry record updated Sep 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Legal business name
BRAINWORKS PEDIATRIC GROUP LLC
Practice address
2120 Bryan Valley Commercial Dr
O Fallon, MO 63366-3495
Phone
(636) 240-8096
Fax
(636) 272-4484
NPI assigned
Sep 17, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2014

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

Authorized official

Name
Mrs. Michelle Brockelmann
Title
Managing Partner/Owner
Phone
(636) 240-8096

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X Primary

Addresses

Primary practice location

2120 Bryan Valley Commercial Dr
O Fallon, MO 63366-3495

Mailing address

2120 Bryan Valley Commercial Dr
O Fallon, MO 63366-3495
Phone (636) 240-8096

National Provider Directory

National Provider Directory

Locations

2120 Bryan Valley Commercial Dr
O Fallon, MO 63366
Phone (314) 774-1859

Practitioners & affiliated clinicians

Practitioners 10

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

NPI Registry JSON

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

{
    "created_epoch": "1410912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410912000000",
    "number": "1306248794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2120 BRYAN VALLEY COMMERCIAL DR",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633663495",
            "telephone_number": "636-240-8096",
            "fax_number": "636-272-4484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2120 BRYAN VALLEY COMMERCIAL DR",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633663495",
            "telephone_number": "636-240-8096",
            "fax_number": "636-272-4484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAINWORKS PEDIATRIC GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-17",
        "last_updated": "2014-09-17",
        "status": "A",
        "authorized_official_last_name": "BROCKELMANN",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "MANAGING PARTNER/OWNER",
        "authorized_official_telephone_number": "636-240-8096",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in O Fallon, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.