NPIMap

Organization Active NPI

Orthotic and Prosthetic Lab, Inc.

  • Prosthetic/Orthotic Supplier
  • Saint Louis, MO
National Provider Identifier
1467513317
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
777 S New Ballas Rd
Suite 116
Saint Louis, MO 63141-8705
Phone
(314) 567-7775
NPI assigned
Dec 13, 2006
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. David J Osterman
Title
Owner
Phone
(314) 968-8555

Specialties & licenses 3

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

Addresses

Primary practice location

777 S New Ballas Rd
Suite 116
Saint Louis, MO 63141-8705

Mailing address

748 Marshall Ave
Saint Louis, 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
O20200410000264 MO DME Supplier - Medical Supply Company With Orthotic-ProstheticDME Supplier - Medical Supply Company With Prosthetic PersonnelDME Supplier - Orthotic PersonnelDME Supplier - Prosthetic PersonnelDME Supplier - Medical Supply Company With Pedorthic Personnel 5496872798 Practice locations: Creve Coeur, MO

Other NPIs with the same Medicare PAC ID 3

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

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.

Locations

777 S New Ballas Rd
Ste 116
Saint Louis, MO 63141
Phone (314) 567-7775

NPI Registry JSON

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487203200000",
    "number": "1467513317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "748 MARSHALL AVE",
            "city": "SAINT LOUIS",
            "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": "777 S NEW BALLAS RD",
            "address_2": "SUITE 116",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418705",
            "telephone_number": "314-567-7775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOTIC AND PROSTHETIC LAB, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2017-02-16",
        "status": "A",
        "authorized_official_last_name": "OSTERMAN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "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": "213.000099",
            "primary": true
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "IL",
            "license": "211.000024",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "621818608",
            "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 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.