NPIMap

Organization Active NPI

Northwest Infectious Disease Services LLC

  • Infectious Disease Physician
  • Bridgeton, MO
National Provider Identifier
1306891551
Registry record updated Dec 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
Legal business name
NORTHWEST INFECTIOUS DISEASE SERVICES LLC
Practice address
12774 Boenker LN
Bridgeton, MO 63044
Phone
(314) 291-7997
Fax
(314) 739-1471
NPI assigned
May 24, 2006
Last updated
Dec 21, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2023

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

Authorized official

Name
Mr. Phillip G Zinser, MDNPI 1750346904
Title
Managing Partner
Phone
(314) 291-7997

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RI0200X Primary

Addresses

Primary practice location

12774 Boenker LN
Bridgeton, MO 63044

Mailing address

PO Box 776874
Chicago, IL 60677-6874
Phone (314) 291-7997

Other practice location 1

11125 Dunn Rd
Ste 412
St Louis, MO 63136-6148
Phone (314) 355-7997

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041206000860 MO Part B Supplier - Clinic/Group Practice 0446216063 Receives reassigned benefits from 9 practitioners
Practice locations: Bridgeton, MO; Saint Charles, MO; Saint Louis, MO; Saint Peters, MO
O20161012001851 IL Part B Supplier - Clinic/Group Practice 0446216063 Receives reassigned benefits from 1 practitioner
Practice locations: Alton, IL; Jerseyville, IL

National Provider Directory

National Provider Directory

Locations

12774 Boenker Ln
Bridgeton, MO 63044
Phone (314) 291-7997

11125 Dunn Rd
Ste 412
Saint Louis, MO 63136
Phone (314) 355-7997

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703116800000",
    "number": "1306891551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776874",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606776874",
            "telephone_number": "314-291-7997",
            "fax_number": "314-739-1471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12774 BOENKER LN",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "63044",
            "telephone_number": "314-291-7997",
            "fax_number": "314-739-1471"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11125 Dunn Rd",
            "address_2": "Ste 412",
            "address_purpose": "LOCATION",
            "city": "St Louis",
            "state": "MO",
            "postal_code": "631366148",
            "country_code": "US",
            "telephone_number": "314-355-7997",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NORTHWEST INFECTIOUS DISEASE SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-24",
        "last_updated": "2023-12-21",
        "certification_date": "2023-12-21",
        "status": "A",
        "authorized_official_last_name": "ZINSER",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "314-291-7997",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeton, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.