Bard and Didriksen Pediatrics, P.C.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

BARD AND DIDRIKSEN PEDIATRICS, P.C.

Practice address

2160 So Il RT 157
Suite B
Glen Carbon, IL 62034

Phone

(618) 692-1212

Fax

(618) 692-4875

NPI assigned

Oct 18, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Stephanie Marie Sudholt

Title

Office Manager

Phone

(618) 692-1212

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 8

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.

• Angela Leigh Bard Kaericher, M.D.

  • Pediatrics Physician
  • Glen Carbon, IL
  • NPI 1043313224
  NPD (past)
• Lizbeth Hoepli Didriksen, M.D.

  • Pediatrics Physician
  • Glen Carbon, IL
  • NPI 1861501058
  NPD (past)
• David Brian Herman, M.D.

  • Pediatrics Physician
  • Glen Carbon, IL
  • NPI 1205945417
  NPD (past)
• Jennifer Susan Hulsen, M.D.

  • Pediatrics Physician
  • Glen Carbon, IL
  • NPI 1083707756
  NPD (past)
• Karen Nauman, MD

  • Pediatrics Physician
  • Glen Carbon, IL
  • NPI 1306819099
  NPD (past)
• Christopher Robert Wangard, M.D.

  • Pediatrics Physician
  • Maryville, IL
  • NPI 1023127396
  NPD (past)
• Tori Erin Boyer, PNP

  • Pediatric Nurse Practitioner
  • Saint Louis, MO
  • NPI 1699434563
  NPD (past)
• Jeong Nam Kim-Judd, MD

  • Pediatrics Physician
  • Hazelwood, MO
  • NPI 1013100122
  NPD (past)

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1669553186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2160 SO. IL. RT. 157",
            "address_2": "SUITE B",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "62034",
            "telephone_number": "618-692-1212",
            "fax_number": "618-692-4875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2160 SO IL RT 157",
            "address_2": "SUITE B",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "62034",
            "telephone_number": "618-692-1212",
            "fax_number": "618-692-4875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BARD AND DIDRIKSEN PEDIATRICS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SUDHOLT",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "618-692-1212",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Apex Physical Therapy, LLC (ApexNetwork Physical Therapy)
• Apex Physical Therapy, LLC (ApexNetwork Physical Therapy)
• Apexnetwork Medical Group, LLC
• Aspire Therapy PLLC
• Axes Physical Therapy, LLC
• Angela Leigh Bard Kaericher, M.D.
• Moira M Barone, PT, ATC
• Sarah Lindsey Bartlett, CF-SLP
• Derek Bastian, MA
• Elizabeth Bauer Hite, DMD MS

• Pediatrics Physician in Glen Carbon, IL
• Providers in Glen Carbon, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.