NPIMap

Organization Active NPI

St Peters Bone & Joint Surgery Inc.

Doing business as Advanced Bone & Joint

  • Orthopaedic Surgery Physician
  • O'Fallon, MO
National Provider Identifier
1386010684
Registry record updated Mar 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
ST PETERS BONE & JOINT SURGERY INC.
Doing business as
Advanced Bone & Joint
Practice address
4701 Highway K
O Fallon, MO 63368-8692
Phone
(636) 441-3444
Fax
(636) 441-9832
NPI assigned
Aug 20, 2015
Last updated
Mar 16, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2025

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

Authorized official

Name
Mr. Jim P Kidd
Title
Ceo
Phone
(636) 441-3444

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Prosthetic/Orthotic Supplier 335E00000X
Orthopaedic Surgery Physician 207X00000X Primary
Orthopaedic Surgery of the Spine Physician 207XS0117X
Orthopaedic Foot and Ankle Surgery Physician 207XX0004X

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 1

  • Advanced Bone & Joint Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161103002587 MO DME Supplier - Physician - Orthopedic/Orthopedic Surgery 8527120492 Practice locations: Wentzville, MO

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

4701 Highway K
O Fallon, MO 63368
Phone (636) 441-3444

Practitioners & affiliated clinicians

Practitioners 27

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 27

NPI Registry JSON

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

{
    "created_epoch": "1440028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742083200000",
    "number": "1386010684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 430",
            "city": "SAINT PETERS",
            "state": "MO",
            "postal_code": "633760008",
            "telephone_number": "636-441-3444",
            "fax_number": "636-441-9832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4701 HIGHWAY K",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633688692",
            "telephone_number": "636-441-3444",
            "fax_number": "636-441-9832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST PETERS BONE & JOINT SURGERY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-20",
        "last_updated": "2025-03-16",
        "certification_date": "2025-03-16",
        "status": "A",
        "authorized_official_last_name": "KIDD",
        "authorized_official_first_name": "JIM",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "636-441-3444",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207XS0117X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207XX0004X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Foot and Ankle Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Bone & Joint",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Mar 16, 2025; 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.