Individual provider Active NPI

Jeffrey Blake Lanter, DPT

  • Physical Therapist
  • Saint Louis, MO
National Provider Identifier
1609618396
Registry record updated Apr 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2024024564 Issued in MO
Practice address
4240 Duncan Ave
Dept Physical Therapy, Ste 120
Saint Louis, MO 63110-1101
Phone
(314) 286-1940
Fax
(314) 286-1473
NPI assigned
Jun 12, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2024024564 MO Primary

Addresses

Primary practice location

4240 Duncan Ave
Dept Physical Therapy, Ste 120
Saint Louis, MO 63110-1101

Mailing address

PO Box 7412011
Chicago, IL 60674-2011
Phone (314) 286-1940

Other identifiers 1

IdentifierTypeStateIssuer
480142941MedicaidMO

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Washington University

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240803000375 MO Practitioner - Physical Therapist in Private Practice 1254878598 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Washington University School of Medicine, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Washington UniversityGroup PAC ID 9830008770, 2,968 clinicians

Practice addresses (Care Compare)

4240 Duncan Ave
Suite 120
Saint Louis, MO 63110-1123
Phone (314) 286-1940

4444 Forest Park Ave
Saint Louis, MO 63108-2212

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2024024564MOMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Washington University Physical Therapist CurrentSince Jul 1, 2024 Accepting new patients
Washington University CurrentSince Jul 1, 2024 Accepting new patients

Locations

4240 Duncan Ave
Ste 120
Saint Louis, MO 63110

660 S Euclid Ave
Saint Louis, MO 63110

4444 Forest Park Ave
Ste 1210
Saint Louis, MO 63108

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1718150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744848000000",
    "number": "1609618396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7412011",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606742011",
            "telephone_number": "314-286-1940",
            "fax_number": "314-286-1473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4240 DUNCAN AVE",
            "address_2": "DEPT PHYSICAL THERAPY, STE 120",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101101",
            "telephone_number": "314-286-1940",
            "fax_number": "314-286-1473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANTER",
        "first_name": "JEFFREY",
        "middle_name": "BLAKE",
        "name_prefix": "Mr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-12",
        "last_updated": "2025-04-17",
        "certification_date": "2024-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "2024024564",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "480142941",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "4240 Duncan Ave",
            "address_2": "Dept Physical Therapy, Ste 120",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631101101",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "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 Apr 17, 2025; 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.