Organization Active NPI

Chesterfield Plastic & Reconstructive Surgery LLC

  • Plastic Surgery Physician
  • Chesterfield, MO
National Provider Identifier
1457791543
Registry record updated Mar 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
Legal business name
CHESTERFIELD PLASTIC & RECONSTRUCTIVE SURGERY LLC
Practice address
111 Saint Lukes Center Dr Ste 46B
Chesterfield, MO 63017-3509
Phone
(314) 205-6420
Fax
(314) 590-5950
NPI assigned
Jul 3, 2013
Organization subpart
Yes
Parent organization
ST LUKE'S MEDICAL GROUPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 5, 2026

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

Authorized official

Name
James Snider
Title
VP Physician Network
Phone
(636) 685-7804

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208200000X Primary

Addresses

Primary practice location

111 Saint Lukes Center Dr Ste 46B
Chesterfield, MO 63017-3509

Mailing address

121 Saint Lukes Center Dr
Chesterfield, MO 63017-3518
Phone (636) 685-7804

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131030001568 MO Part B Supplier - Clinic/Group Practice 6608001573 Receives reassigned benefits from 2 practitioners
Practice locations: Chesterfield, MO

National Provider Directory

National Provider Directory
Part of
St Lukes Medical Group

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1372809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1772668800000",
    "number": "1457791543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 SAINT LUKES CENTER DR",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630173518",
            "telephone_number": "636-685-7804",
            "fax_number": "314-576-2344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 SAINT LUKES CENTER DR STE 46B",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630173509",
            "telephone_number": "314-205-6420",
            "fax_number": "314-590-5950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHESTERFIELD PLASTIC & RECONSTRUCTIVE SURGERY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST LUKE'S MEDICAL GROUP",
        "enumeration_date": "2013-07-03",
        "last_updated": "2026-03-05",
        "certification_date": "2026-03-05",
        "status": "A",
        "authorized_official_last_name": "SNIDER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "VP PHYSICIAN NETWORK",
        "authorized_official_telephone_number": "636-685-7804"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chesterfield, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2026; 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.