St Peters Bone & Joint Surgery Inc.
Organization Active NPI Orthopaedic Surgery Physician · O Fallon, MO
NPI 1386010684 · NPPES record last updated Mar 16, 2025
Key facts
- NPI
- 1386010684
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Orthopaedic Surgery Physician 207X00000X
- Legal business name
- ST PETERS BONE & JOINT SURGERY INC.
- Practice address
- 4701 Highway K
O Fallon, MO 63368-8692 - Phone
- (636) 441-3444
- Fax
- (636) 441-9832
- NPI assigned
- Aug 20, 2015
- Organization subpart
- No
Authorized official
- Name
- Mr. Jim P Kidd
- Title
- Ceo
- Phone
- (636) 441-3444
Other NPIs with the same Medicare PAC ID 2
Practitioners 37
-
Joy Nicole Bittle, P.A.-C
-
Jeffrey Steven Boberg, D.P.M.
-
Samantha Bunch, APRN FNP-BC
-
Zachary Patrick Fallon, M.D.
-
Sara K Herbert, FNP-BC
-
Matthew Anthony Pliske, PA-C
-
Chad E Schmitz, PA
-
Karly Alexa Sheppard, FNP
-
Tiffany Ann Simon, PA-C
-
Abigail June Williams, PA-C
-
Nicholas J Zarkadis, D.O.
-
Jennifer Michelle Eickhoff, FNP-BC, MSN ATC, LAT
-
Dane A. Glueck, MD
-
Matthew Hammer, FNP-BC
-
Anthony M Lombardo, DPM
-
Leslie A Simpson, NP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20161103002587 | MO | DME Supplier - Physician - Orthopedic/Orthopedic Surgery | 8527120492 | Practice locations: Wentzville, MO |
National Provider Directory
Locations
4701 Highway K
O Fallon, MO 63368
Phone (636) 441-3444
114 Piper Hill Dr
Ste 101
Saint Peters, MO 63376
Phone (636) 706-0560
378 Shadow Pines Dr
Wentzville, MO 63385
Phone (636) 441-3444
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician |
207X00000X | Yes | ||
| Orthopaedic Surgery of the Spine Physician |
207XS0117X | |||
| Orthopaedic Foot and Ankle Surgery Physician |
207XX0004X | |||
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Prosthetic/Orthotic Supplier | 335E00000X |
Addresses
Primary practice location
4701 Highway K
O Fallon, MO 63368-8692
Mailing address
PO Box 430
Saint Peters, MO 63376-0008
Phone (636) 441-3444
Other names
- Advanced Bone & Joint
Other providers in O Fallon, MO
- SSM Medical Group Inc.
- SSM Medical Group, Inc.
- SSM Select Rehab St Louis LLC
- SSM Select Rehab St. Louis, LLC
- St Lukes Episcopal Presbyterian Hospital
- St. Charles County Association for Retarded Citizens
- St. Charles Sports&Physical Therapy, Inc.
- St. John'S Mercy Support Services
- Heather St. Peter
- Sarah Staats
All providers in O Fallon, MO · Orthopaedic Surgery Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 16, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.