NPIMap

Individual provider Active NPI

Jack Roh Oak, MD

  • Vascular Surgery Physician
  • Bridgeton, MO
National Provider Identifier
1326269648
Registry record updated Aug 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
2003009197 Issued in MO
Practice address
12266 De Paul Dr Ste 305
Bridgeton, MO 63044-2514
Phone
(314) 770-0991
NPI assigned
May 2, 2007
Last updated
Aug 1, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X 2003009197 MO Primary

Addresses

Primary practice location

12266 De Paul Dr Ste 305
Bridgeton, MO 63044-2514

Mailing address

660 S Euclid Ave
MSC 8109-05-04
Saint Louis, MO 63110-1010
Phone (314) 991-4644

Other practice location 1

555 N New Ballas Rd
Div Surg Vascular, Ste 265
Saint Louis, MO 63141-6825
Phone (314) 991-4644

Other identifiers 1

IdentifierTypeStateIssuer
209363209MedicaidMO

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Washington University

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, SC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20041124000066 MO Practitioner - Vascular SurgeryPractitioner - General Surgery 2062477573 Reassigns benefits to 1 organization
I20220927002242 SC Practitioner - Vascular Surgery 2062477573 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Vascular SurgeryAlso: General Surgery
Education
University of California, San Diego School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SSM Medical Group IncGroup PAC ID 6608776299, 565 clinicians

Practice addresses (Care Compare)

12266 De Paul Dr
Suite 305
Bridgeton, MO 63044-2514
Phone (314) 770-0991

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion18
Melanoma (skin cancer) excision1-10
Leg revascularization (restoring blood flow)25
Removal of tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Anmed Health CurrentSince Aug 1, 2022 Accepting new patients
Anmed Health CurrentSince Aug 1, 2022 Accepting new patients
SSM Medical Group Inc. CurrentSince Jul 6, 2023 Accepting new patients
Anmed Health Current Accepting new patients
SSM Medical Group, Inc. CurrentSince Jul 6, 2023 Accepting new patients
Anmed Health Current Accepting new patients
Anmed Health CurrentSince Aug 1, 2022 Accepting new patients
St Louis Surgical Consultants, P.C. PastSince Dec 31, 1991 Accepting new patients
MB Professional Billing Services, LLC Past Accepting new patients
St. Lukes Medical Group PastSince Dec 31, 2023 Accepting new patients
SSM Depaul Medical Group, Inc. Past Accepting new patients

Locations

12266 De Paul Dr
Ste 305
Bridgeton, MO 63044
Phone (314) 770-0991

1035 Bellevue Ave
Ste 500
Saint Louis, MO 63117
Phone (314) 647-1115

3555 Sunset Office Dr
Ste C100
Saint Louis, MO 63127
Phone (314) 238-9100

2000 E Greenville St
Fl 3
Anderson, SC 29621
Phone (864) 225-5131

2000 E Greenville St
Ste 2500
Anderson, SC 29621
Phone (864) 224-1111

800 N Fant St
Anderson, SC 29621
Phone (864) 512-1000

Interoperability endpoints

  • FHIR API: https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
  • Direct secure messaging: joak11102@direct.carenet.org
  • Direct secure messaging: joak482020@direct-ehr-ssmhc.com
  • Direct secure messaging: joak53358@direct.anmedhealth.net

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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": "1178064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690848000000",
    "number": "1326269648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "660 S EUCLID AVE",
            "address_2": "MSC 8109-05-04",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101010",
            "telephone_number": "314-991-4644",
            "fax_number": "314-991-4910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12266 DE PAUL DR STE 305",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442514",
            "telephone_number": "314-770-0991"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "555 N New Ballas Rd",
            "address_2": "Div Surg Vascular, Ste 265",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631416825",
            "country_code": "US",
            "telephone_number": "314-991-4644",
            "fax_number": "314-991-4910",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OAK",
        "first_name": "JACK",
        "middle_name": "ROH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-02",
        "last_updated": "2023-08-01",
        "certification_date": "2023-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "MO",
            "license": "2003009197",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "209363209",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "555 N New Ballas Rd",
            "address_2": "Div Surg Vascular, Ste 265",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631416825",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bridgeton, MO

Sources for this page

Verify at the official NPI Registry.