Active NPI
Thomas Richard Weber, MD
- Pediatric Surgery Physician
- Saint Louis, MO
National Provider Identifier
1700808045
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Surgery Physician
- License
- 01029263A
- Practice address
- 621 S New Ballas Rd
Suite 6018B
Saint Louis, MO 63141-8232 - Phone
- (314) 251-5940
- NPI assigned
- Jul 24, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Surgery Physician | 2086S0120X | 01029263A | IN | Primary |
| Pediatric Surgery Physician | 2086S0120X | 240390 | NY | |
| Pediatric Surgery Physician | 2086S0120X | 036121829 | IL | |
| Pediatric Surgery Physician | 2086S0120X | 2014039525 | MO |
Addresses
Primary practice location
621 S New Ballas Rd
Suite 6018B
Saint Louis, MO 63141-8232
Mailing address
6626 E 75TH St
Suite 500
Indianapolis, IN 46250-2805
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P01291673 | Other | IN | RAILROAD MEDICARE |
| 201142010 | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2014039525 | MO | MD | Pediatric Surgery Physician |
| 240390 | NY | MD | Pediatric Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153699200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1436486400000",
"number": "1700808045",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6626 E 75TH ST",
"address_2": "SUITE 500",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462502805"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "621 S NEW BALLAS RD",
"address_2": "SUITE 6018B",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631418232",
"telephone_number": "314-251-5940"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEBER",
"first_name": "THOMAS",
"middle_name": "RICHARD",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-24",
"last_updated": "2015-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "2086S0120X",
"taxonomy_group": "",
"desc": "Surgery, Pediatric Surgery",
"state": "IN",
"license": "01029263A",
"primary": true
},
{
"code": "2086S0120X",
"taxonomy_group": "",
"desc": "Surgery, Pediatric Surgery",
"state": "NY",
"license": "240390",
"primary": false
},
{
"code": "2086S0120X",
"taxonomy_group": "",
"desc": "Surgery, Pediatric Surgery",
"state": "IL",
"license": "036121829",
"primary": false
},
{
"code": "2086S0120X",
"taxonomy_group": "",
"desc": "Surgery, Pediatric Surgery",
"state": "MO",
"license": "2014039525",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P01291673",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "201142010",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.