Northwest Otolaryngology, Inc

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

NORTHWEST OTOLARYNGOLOGY, INC

Practice address

12255 De Paul Dr Ste 830N
Bridgeton, MO 63044-2510

Phone

(314) 291-5307

Fax

(314) 291-0838

NPI assigned

Dec 27, 2007

Organization subpart

No

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

Authorized official

Name

Melissa Budzinski

Title

Billing Manager

Phone

(636) 379-6006

Specialties & licenses 1

Addresses

Other names 1

• NORTHWEST OTOLARYNGOLOGY Doing business as

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Locations

Practitioners 4

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

• Jason Matthew Hanson, M.D.

  • Otolaryngology Physician
  • Bridgeton, MO
  • NPI 1063522597

  MO, Specialist

  Medicare reassignment Care Compare group NPD
• Janet Napoli, AU.D.

  • Audiologist
  • Bridgeton, MO
  • NPI 1942470901

  MO

  Medicare reassignment Care Compare group NPD
• John Joseph Bonacorsi, M.D.

  • Specialist
  • Bridgeton, MO
  • NPI 1265541395
  NPD (past)
• George Thomas Shuert, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Bridgeton, MO
  • NPI 1104932854
  NPD (past)

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

{
    "created_epoch": "1198713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571097600000",
    "number": "1578747408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12255 DE PAUL DR STE 830N",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442510",
            "telephone_number": "314-291-5307",
            "fax_number": "314-291-0838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12255 DE PAUL DR STE 830N",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442510",
            "telephone_number": "314-291-5307",
            "fax_number": "314-291-0838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST OTOLARYNGOLOGY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-27",
        "last_updated": "2019-10-15",
        "status": "A",
        "authorized_official_last_name": "BUDZINSKI",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "636-379-6006"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NORTHWEST OTOLARYNGOLOGY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "NORTHWEST OTOLARYNGOLOGY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Francis Ntimba, M.D.
• Nucrown, LLC
• Rachel Elizabeth O'Bannon, MS CCC-SLP CBIS
• Kelly O'Brien, DPT
• Laura Elizabeth O'Neal

• All providers in Bridgeton, MO
• Specialist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2019; 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.