NPIMap

Organization Active NPI

Orthotic and Prosthetic Lab, Inc.

  • Prosthetic/Orthotic Supplier
  • Bridgeton, MO
National Provider Identifier
1427212471
Registry record updated Feb 16, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
License
213.000099 Issued in IL
Legal business name
ORTHOTIC AND PROSTHETIC LAB, INC.
Practice address
12266 Depaul Dr
Suite 120
Bridgeton, MO 63044-2514
Phone
(314) 739-9300
NPI assigned
Jul 17, 2008
Last updated
Feb 16, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2017

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

Authorized official

Name
Mr. Dave J Osterman
Title
President
Phone
(314) 968-8555

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Prosthetic/Orthotic Supplier 335E00000X 211.000024 IL
Prosthetic/Orthotic Supplier 335E00000X 213.000099 IL Primary

Addresses

Primary practice location

12266 Depaul Dr
Suite 120
Bridgeton, MO 63044-2514

Mailing address

748 Marshall Ave
Webster Groves, MO 63119-1924
Phone (314) 968-8555

Other identifiers 1

IdentifierTypeStateIssuer
621818608MedicaidMO

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200417000159 MO DME Supplier - Medical Supply Company With Orthotic-Prosthetic 5496872798 Practice locations: Bridgeton, MO

Other NPIs with the same Medicare PAC ID 3

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Orthotic & Prosthetic Lab, Inc.12266 Depaul Drive, Bridgeton, MO 63044-2514(314) 739-9300 Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf|Limb Prostheses|Diabetic Shoes and Inserts|Diabetic Shoes/Inserts - Custom|Lymphedema Compression Treatment Items Does not accept assignmentParticipating since Jan 1, 1998

National Provider Directory

National Provider Directory
Tax ID family
Orthotic and Prosthetic Lab Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1216252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487203200000",
    "number": "1427212471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "748 MARSHALL AVE",
            "city": "WEBSTER GROVES",
            "state": "MO",
            "postal_code": "631191924",
            "telephone_number": "314-968-8555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12266 DEPAUL DR",
            "address_2": "SUITE 120",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442514",
            "telephone_number": "314-739-9300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOTIC AND PROSTHETIC LAB, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-17",
        "last_updated": "2017-02-16",
        "status": "A",
        "authorized_official_last_name": "OSTERMAN",
        "authorized_official_first_name": "DAVE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "314-968-8555",
        "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": "IL",
            "license": "211.000024",
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "IL",
            "license": "213.000099",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "621818608",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeton, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.