NPIMap

Organization Active NPI

Orthopedic and Spine Institute of St. Louis, LLC

  • Orthopaedic Surgery Physician
  • Saint Louis, MO
National Provider Identifier
1356853683
Registry record updated Feb 7, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
ORTHOPEDIC AND SPINE INSTITUTE OF ST. LOUIS, LLC
Practice address
10435 Clayton Rd
Ste 120
Saint Louis, MO 63131
Phone
(314) 442-4452
Fax
(866) 216-3928
NPI assigned
Oct 26, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2019

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

Authorized official

Name
Michelle R Dickison, RN
Title
Practice Administrator
Phone
(314) 808-3173

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207X00000X Primary
Orthopaedic Surgery of the Spine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207XS0117X
Sports Medicine (Orthopaedic Surgery) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207XX0005X

Addresses

Primary practice location

10435 Clayton Rd
Ste 120
Saint Louis, MO 63131

Mailing address

10435 Clayton Rd Ste 120
Saint Louis, MO 63131-2930
Phone (314) 442-4452

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171207000742 MO Part B Supplier - Clinic/Group Practice 7113284704 Receives reassigned benefits from 5 practitioners
Practice locations: Saint Louis, MO

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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": "1508976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549497600000",
    "number": "1356853683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10435 CLAYTON RD STE 120",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631312930",
            "telephone_number": "314-442-4452",
            "fax_number": "866-216-3928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10435 CLAYTON RD",
            "address_2": "STE 120",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "63131",
            "telephone_number": "314-442-4452",
            "fax_number": "866-216-3928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOPEDIC AND SPINE INSTITUTE OF ST. LOUIS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-26",
        "last_updated": "2019-02-07",
        "status": "A",
        "authorized_official_last_name": "DICKISON",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "314-808-3173",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207XS0117X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2019; 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.