Jeffrey S Boberg DPM LLC

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

000570 Issued in MO

Legal business name

JEFFREY S BOBERG DPM LLC

Practice address

12255 De Paul Dr
Ste 100
Bridgeton, MO 63044-2510

Phone

(314) 739-7100

Fax

(314) 739-3199

NPI assigned

Aug 31, 2006

Organization subpart

No

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

Authorized official

Name

Jeffrey S Boberg, DPM

Title

President/Physician

Phone

(314) 739-7100

Specialties & licenses 6

Addresses

Other identifiers 3

Other names 1

• Ankle & Foot Surgeons of the Midwest Doing business as

Locations

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

• Matthew J Claxton, DPM

  • Podiatrist
  • Saint Louis, MO
  • NPI 1457466989

  Foot & Ankle Surgery

  NPD (past)
• Nicolas Clay Martin, D.P.M.

  • Foot & Ankle Surgery Podiatrist
  • Saint Louis, MO
  • NPI 1477668606

  Foot & Ankle Surgery

  NPD (past)
• Erica L Torgrude, DPM

  • Podiatrist
  • Webster Groves, MO
  • NPI 1366422115

  Foot & Ankle Surgery

  NPD (past)

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1258934400000",
    "number": "1639280290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12255 DE PAUL DR",
            "address_2": "STE 100",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442510",
            "telephone_number": "314-739-7100",
            "fax_number": "314-739-3199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12255 DE PAUL DR",
            "address_2": "STE 100",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442510",
            "telephone_number": "314-739-7100",
            "fax_number": "314-739-3199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFREY S BOBERG DPM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2009-11-23",
        "status": "A",
        "authorized_official_last_name": "BOBERG",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT/PHYSICIAN",
        "authorized_official_telephone_number": "314-739-7100",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "MO",
            "license": "000570",
            "primary": true
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "IL",
            "license": "016004233",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "MO",
            "license": "2005026457",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "IL",
            "license": "016005217",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "MO",
            "license": "2003013610",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "IL",
            "license": "016005131",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500008107",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DC4793",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DA9953",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ankle & Foot Surgeons of the Midwest",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Keith H. Jamerson
• James T Moore, DDS, PC
• Wanna Janwatanagool, PHARMD
• Mohammad Ali Javed, DO
• Jeff L Jefferson, BA
• Emily Nicole Jensen
• Jermik Systems, LTD
• John P Hoehn III MD Facs PC
• Kristy B Johnson-Herrell, MA, LPC
• Lakita A Johnson-Holmes, PHARM D

• All providers in Bridgeton, MO
• Foot & Ankle Surgery Podiatrist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.