NPIMap

Organization Active NPI

Greater St Louis Oral & Maxillofacial Surgery PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Saint Louis, MO
National Provider Identifier
1518158989
Registry record updated Feb 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
GREATER ST LOUIS ORAL & MAXILLOFACIAL SURGERY PC
Practice address
1034 S Brentwood Blvd
Suite 1010
Saint Louis, MO 63117-1223
Phone
(314) 721-1010
Fax
(314) 721-5276
NPI assigned
Aug 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2020

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

Authorized official

Name
Dr. John R Monterubio, DDSNPI 1225147853
Title
President
Phone
(314) 721-1010

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X Primary

Addresses

Primary practice location

1034 S Brentwood Blvd
Suite 1010
Saint Louis, MO 63117-1223

Mailing address

1034 S Brentwood Blvd
Suite 1010
Saint Louis, MO 63117-1223
Phone (314) 721-1010

Other names 1

  • Monterubio and Herbosa Oral and Maxillofacial Surgery Former legal business name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address office@mhoms.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110107000948 MO Part B Supplier - Clinic/Group Practice 4981893823 Receives reassigned benefits from 4 practitioners
Practice locations: Saint Louis, MO

National Provider Directory

National Provider Directory

Locations

1040 N Mason Rd
Ste 204
Saint Louis, MO 63141

1 Barnes Hospital
Ste 230
Saint Louis, MO 63110
Phone (314) 361-6006

12818 Tesson Ferry Rd
Ste 204
Saint Louis, MO 63128
Phone (314) 722-2033

12810 Tesson Ferry Rd
Saint Louis, MO 63128
Phone (314) 842-0020

1 Barnes Jewish Hospital Plz
#230
Saint Louis, MO 63110

1 Barnes Jewish Hospital Plz
Ste 230
Saint Louis, MO 63110
Phone (314) 361-6006

1040 N Mason Rd
Ste 207
Saint Louis, MO 63141
Phone (314) 453-9705

Practitioners & affiliated clinicians

Practitioners 8

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": "1186617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581465600000",
    "number": "1518158989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1034 S BRENTWOOD BLVD",
            "address_2": "SUITE 1010",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631171223",
            "telephone_number": "314-721-1010",
            "fax_number": "314-721-5276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1034 S BRENTWOOD BLVD",
            "address_2": "SUITE 1010",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631171223",
            "telephone_number": "314-721-1010",
            "fax_number": "314-721-5276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREATER ST LOUIS ORAL & MAXILLOFACIAL SURGERY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-09",
        "last_updated": "2020-02-12",
        "certification_date": "2020-02-12",
        "status": "A",
        "authorized_official_last_name": "MONTERUBIO",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "314-721-1010",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "office@mhoms.com",
            "affiliation": "N",
            "endpointDescription": "Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1034 S Brentwood Blvd",
            "address_2": "Suite 1010",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631171223",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Monterubio and Herbosa Oral and Maxillofacial Surgery",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Monterubio and Herbosa Oral and Maxillofacial Surgery",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 12, 2020; 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.