Individual provider Active NPI

Matthew W. Bruns, CNP

  • Nurse Practitioner
  • Bridgeton, MO
National Provider Identifier
1447266333
Registry record updated Oct 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
2018022966 Issued in MO
Practice address
12349 De Paul Dr Ste 100
Bridgeton, MO 63044-2512
Phone
(314) 291-7900
NPI assigned
Jul 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 209006084 IL
Nurse Practitioner 363L00000X 2018022966 MO Primary

Addresses

Primary practice location

12349 De Paul Dr Ste 100
Bridgeton, MO 63044-2512

Mailing address

PO Box 955534
Saint Louis, MO 63195-4038

Other practice location 1

1025 Maine St
Quincy, IL 62301-4038
Phone (217) 222-6550

Other identifiers 1

IdentifierTypeStateIssuer
209006084OtherILILLINOIS LICENSE NUMBER

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address mbruns372112@direct-ehr-ssmhc.com Direct
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181119002388 MO Practitioner - Nurse Practitioner 4981609625 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SSM Medical Group IncGroup PAC ID 6608776299, 565 clinicians

Practice addresses (Care Compare)

12349 De Paul Dr
Suite 100
Bridgeton, MO 63044-2512
Phone (314) 291-7900

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
2018022966MOMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
SSM Medical Group, Inc. CurrentSince Apr 1, 2020 Accepting new patients
SSM Medical Group Inc. CurrentSince Apr 1, 2020 Accepting new patients
Orthopedic Health of Kansas City P.C. CurrentSince Dec 5, 2019 Accepting new patients
Memorial Hospital Association Past Accepting new patients

Locations

12349 De Paul Dr
Ste 100
Bridgeton, MO 63044
Phone (314) 291-3399

6675 Holmes Rd
Ste 400
Kansas City, MO 64131
Phone (816) 303-2400

1950 Diamond Pkwy
Ste 100
North Kansas City, MO 64116
Phone (816) 561-3003

3555 Sunset Office Dr
Ste C100
Saint Louis, MO 63127
Phone (314) 238-9100

1035 Bellevue Ave
Ste 500
Saint Louis, MO 63117
Phone (314) 647-1115

Interoperability endpoints

  • Direct secure messaging: mbruns372112@direct-ehr-ssmhc.com

Organizations & group practices 4

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603152000000",
    "number": "1447266333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 955534",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631954038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12349 DE PAUL DR STE 100",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442512",
            "telephone_number": "314-291-7900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1025 Maine St",
            "address_purpose": "LOCATION",
            "city": "Quincy",
            "state": "IL",
            "postal_code": "623014038",
            "country_code": "US",
            "telephone_number": "217-222-6550",
            "fax_number": "217-277-2253",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRUNS",
        "first_name": "MATTHEW",
        "middle_name": "W.",
        "name_prefix": "Mr.",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-31",
        "last_updated": "2020-10-20",
        "certification_date": "2020-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209006084",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MO",
            "license": "2018022966",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ILLINOIS LICENSE NUMBER",
            "identifier": "209006084",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mbruns372112@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "mbruns372112@direct-ehr-ssmhc.com",
            "address_1": "12349 De Paul Dr Ste 100",
            "city": "Bridgeton",
            "state": "MO",
            "country_code": "US",
            "postal_code": "630442512",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "12349 De Paul Dr Ste 100",
            "city": "Bridgeton",
            "state": "MO",
            "country_code": "US",
            "postal_code": "630442512",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bridgeton, MO

Sources for this page

Verify at the official NPI Registry.