Individual provider Active NPI

James Michael Brennan, M.D.

  • Obstetrics & Gynecology Physician
  • Saint Louis, MO
National Provider Identifier
1699714360
Registry record updated Mar 14, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
MDR6C99 Issued in MO
Practice address
12700 Southfork Rd
Ste 230
Saint Louis, MO 63128-3201
Phone
(314) 849-3711
Fax
(314) 849-0235
NPI assigned
Jun 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X MDR6C99 MO Primary
Obstetrics & Gynecology Physician 207V00000X 336-069065 IL

Addresses

Primary practice location

12700 Southfork Rd
Ste 230
Saint Louis, MO 63128-3201

Mailing address

12700 Southfork Rd
Ste 230
Saint Louis, MO 63128-3201
Phone (314) 849-3711

Other identifiers 1

IdentifierTypeStateIssuer
202125209MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120629000237 MO Practitioner - Obstetrics/Gynecology 2567648827 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
336-069065ILMDObstetrics & Gynecology Physician
MDR6C99MOMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic East Communities CurrentSince Jan 1, 2020 Accepting new patients
Mercy Clinic East Communities Obstetrics & Gynecology CurrentSince Jan 1, 2020 Accepting new patients
Brennan OB GYN Associate, P.C. Obstetrics & Gynecology Current Accepting new patients

Locations

1011 Bowles Ave
Ste 425
Fenton, MO 63026
Phone (636) 326-2600

5425 Southfield Ctr
Saint Louis, MO 63123
Phone (314) 543-5258

621 S New Ballas Rd
Ste 4017B
Saint Louis, MO 63141
Phone (314) 872-9192

12700 Southfork Rd
Ste 230
Saint Louis, MO 63128
Phone (314) 525-4880

13023 Tesson Ferry Rd
Ste 103
Saint Louis, MO 63128
Phone (314) 849-3711

Organizations & group practices 3

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": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489449600000",
    "number": "1699714360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12700 SOUTHFORK RD",
            "address_2": "STE 230",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631283201",
            "telephone_number": "314-849-3711",
            "fax_number": "314-849-0235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12700 SOUTHFORK RD",
            "address_2": "STE 230",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631283201",
            "telephone_number": "314-849-3711",
            "fax_number": "314-849-0235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRENNAN",
        "first_name": "JAMES",
        "middle_name": "MICHAEL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-06",
        "last_updated": "2017-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MO",
            "license": "MDR6C99",
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IL",
            "license": "336-069065",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "202125209",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.