Individual provider Active NPI

George H. Rezabek, D.O.

  • Pediatrics Physician
  • Fenton, MO
National Provider Identifier
1699741835
Registry record updated Feb 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
R6N18 Issued in MO
Practice address
832 Horan Dr
Fenton, MO 63026-2408
Phone
(636) 349-7191
Fax
(636) 349-9063
NPI assigned
Feb 27, 2006
Last updated
Feb 16, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X R6N18 MO Primary

Addresses

Primary practice location

832 Horan Dr
Fenton, MO 63026-2408

Mailing address

832 Horan Dr
Fenton, MO 63026-2408
Phone (636) 349-7191

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
I20150226000211 MO Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 5193041721

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R6N18MOMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ozarks Medical Center Past Accepting new patients
Mercy Clinic East Communities Pediatrics Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: grezabek256@directc.mercy.net

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1140998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329350400000",
    "number": "1699741835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "832 HORAN DR",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630262408",
            "telephone_number": "636-349-7191",
            "fax_number": "636-349-9063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "832 HORAN DR",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630262408",
            "telephone_number": "636-349-7191",
            "fax_number": "636-349-9063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REZABEK",
        "first_name": "GEORGE",
        "middle_name": "H.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-27",
        "last_updated": "2012-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "R6N18",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fenton, MO

Sources for this page

Verify at the official NPI Registry.