Active NPI
Peter Putnam, M.D.
- Pediatrics Physician
- Saint Louis, MO
National Provider Identifier
1417938176
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 113311
- Practice address
- 9930 Watson Rd
Saint Louis, MO 63126-1827 - Phone
- (314) 965-5437
- Fax
- (314) 965-5439
- NPI assigned
- Nov 9, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 113311 | MO | Primary |
Addresses
Primary practice location
9930 Watson Rd
Saint Louis, MO 63126-1827
Mailing address
PO Box 23340
Saint Louis, MO 63156-3340
Phone (314) 965-5437
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 96948 | Other | MO | GHP |
| 23561V3431 | Other | MO | HEALTHCARE USA |
| 7432234 | Other | MO | AETNA |
| 143223 | Other | MO | BCBS |
| 143223 | Other | MO | BLUE CHOICE |
| 431383893PUT | Other | MO | MERCY |
| 1200670 | Other | MO | UHC |
| 456440 | Other | MO | HEALTHLINK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 113311 | MO | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| American Multispecialty Group Inc. | Pediatrics | Past | Accepting new patients |
Interoperability endpoints
- peter.putnam.p1@direct.essehealth.nextgenshare.com
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Internal Medicine Physician
- Saint Louis, MO
- NPI 1972559532
Pediatrics
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131494400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1348617600000",
"number": "1417938176",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 23340",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631563340",
"telephone_number": "314-965-5437",
"fax_number": "314-965-5439"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9930 WATSON RD",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631261827",
"telephone_number": "314-965-5437",
"fax_number": "314-965-5439"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUTNAM",
"first_name": "PETER",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-09",
"last_updated": "2012-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MO",
"license": "113311",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHP",
"identifier": "96948",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHCARE USA",
"identifier": "23561V3431",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "7432234",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "143223",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CHOICE",
"identifier": "143223",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MERCY",
"identifier": "431383893PUT",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UHC",
"identifier": "1200670",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHLINK",
"identifier": "456440",
"state": "MO"
}
],
"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 Sep 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.