NPIMap

Organization Active NPI

Ortho Missouri, LLC

Doing business as OrthoMO, LLC

  • Orthopaedic Surgery Physician
  • Creve Coeur, MO
National Provider Identifier
1447941067
Registry record updated May 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
ORTHO MISSOURI, LLC
Doing business as
OrthoMO, LLC
Practice address
11330 Olive Blvd Ste 150
Creve Coeur, MO 63141-7149
Phone
(314) 288-9826
NPI assigned
May 16, 2023
Last updated
May 16, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2023

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

Authorized official

Name
Beverly Baker
Title
Market President
Phone
(314) 288-9826

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X Primary

Addresses

Primary practice location

11330 Olive Blvd Ste 150
Creve Coeur, MO 63141-7149

Mailing address

11330 Olive Blvd Ste 150
Creve Coeur, MO 63141-7149
Phone (314) 288-9826

Other names 1

  • OrthoMO, LLC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231206002746 MO Part B Supplier - Clinic/Group Practice 8527417229 Receives reassigned benefits from 10 practitioners
Practice locations: Cape Girardeau, MO; Creve Coeur, MO

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.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D2296612Ortho Missouri, LLC11330 Olive Blvd Suite 150, Creve Coeur, MO 63141Certificate of waiverJan 2, 2028

National Provider Directory

National Provider Directory

Locations

201 S Mount Auburn Rd
Ste C
Cape Girardeau, MO 63703
Phone (573) 381-0780

760 Office Pkwy
Ste 200
Creve Coeur, MO 63141
Phone (314) 782-1994

11330 Olive Blvd
Ste 150
Saint Louis, MO 63141
Phone (314) 336-2566

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1684195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684195200000",
    "number": "1447941067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11330 OLIVE BLVD STE 150",
            "city": "CREVE COEUR",
            "state": "MO",
            "postal_code": "631417149",
            "telephone_number": "314-288-9826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11330 OLIVE BLVD STE 150",
            "city": "CREVE COEUR",
            "state": "MO",
            "postal_code": "631417149",
            "telephone_number": "314-288-9826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHO MISSOURI, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-16",
        "last_updated": "2023-05-16",
        "certification_date": "2023-05-16",
        "status": "A",
        "authorized_official_last_name": "BAKER",
        "authorized_official_first_name": "BEVERLY",
        "authorized_official_title_or_position": "MARKET PRESIDENT",
        "authorized_official_telephone_number": "314-288-9826"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OrthoMO, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Creve Coeur, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2023; 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.