NPIMap

Organization Active NPI

Orthopedic Center of St Louis Img LLC

  • Orthopaedic Surgery Physician
  • Chesterfield, MO
National Provider Identifier
1649041666
Registry record updated Jan 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
ORTHOPEDIC CENTER OF ST LOUIS IMG LLC
Practice address
14825 N Outer 40 Rd Ste 200
Chesterfield, MO 63017-2152
Phone
(314) 336-2555
Fax
(314) 336-2557
NPI assigned
Jan 9, 2024
Last updated
Jan 9, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2024

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

Authorized official

Name
Ken Kilen
Title
Administrator
Phone
(314) 336-2555

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X NU Primary

Addresses

Primary practice location

14825 N Outer 40 Rd Ste 200
Chesterfield, MO 63017-2152

Mailing address

14825 N Outer 40 Rd Ste 200
Chesterfield, MO 63017-2152
Phone (314) 336-2555

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240814002687 MO Part B Supplier - Clinic/Group Practice 5698213221 Receives reassigned benefits from 6 practitioners
Practice locations: Chesterfield, MO

National Provider Directory

National Provider Directory

Locations

14825 North Outer 40 Rd
Ste 200
Chesterfield, MO 63017
Phone (314) 336-2555

203 Dunn Rd
Florissant, MO 63031
Phone (314) 580-9987

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.61217

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1704758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704758400000",
    "number": "1649041666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14825 N OUTER 40 RD STE 200",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630172152",
            "telephone_number": "314-336-2555",
            "fax_number": "314-336-2557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14825 N OUTER 40 RD STE 200",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630172152",
            "telephone_number": "314-336-2555",
            "fax_number": "314-336-2557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOPEDIC CENTER OF ST LOUIS IMG LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-09",
        "last_updated": "2024-01-09",
        "certification_date": "2024-01-09",
        "status": "A",
        "authorized_official_last_name": "KILEN",
        "authorized_official_first_name": "KEN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "314-336-2555"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chesterfield, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2024; 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.