Active NPI
Physician Groups LC
- Primary Care Clinic/Center
- High Ridge, MO
National Provider Identifier
1710053897
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Primary Care Clinic/Center
- Legal business name
- PHYSICIAN GROUPS LC
- Doing business as
- Dillon Plaza Family Medicine
- Practice address
- 1 Dillon Plaza Dr
High Ridge, MO 63049-2478 - Phone
- (636) 677-3012
- Fax
- (636) 677-3174
- NPI assigned
- Nov 28, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Raymond P Davidson II, MD
- Title
- President
- Phone
- (314) 286-2028
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | Primary |
Addresses
Primary practice location
1 Dillon Plaza Dr
High Ridge, MO 63049-2478
Mailing address
670 Mason Ridge Center Dr
Suite 300
Saint Louis, MO 63141-8573
Phone (314) 996-7644
Other names 1
- Dillon Plaza Family Medicine
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040220001157 | MO | Part B Supplier - Clinic/Group Practice | 3072421254 |
Receives reassigned benefits from 611 practitioners 44 other NPIs on this enrollment This NPI is an additional NPI on the enrollment |
Other NPIs on the same Medicare enrollment 44
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Obstetrics & Gynecology Physician
- Saint Peters, MO
- NPI 1043403009
O20040220001157
National Provider Directory
National Provider DirectoryLocations
1 Dillon Plaza Dr
High Ridge, MO 63049
Phone (636) 677-3012
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164672000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1205971200000",
"number": "1710053897",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "670 MASON RIDGE CENTER DR",
"address_2": "SUITE 300",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631418573",
"telephone_number": "314-996-7644",
"fax_number": "314-996-7658"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 DILLON PLAZA DR",
"city": "HIGH RIDGE",
"state": "MO",
"postal_code": "630492478",
"telephone_number": "636-677-3012",
"fax_number": "636-677-3174"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PHYSICIAN GROUPS LC",
"organizational_subpart": "NO",
"enumeration_date": "2006-11-28",
"last_updated": "2008-03-20",
"status": "A",
"authorized_official_last_name": "DAVIDSON",
"authorized_official_first_name": "RAYMOND",
"authorized_official_middle_name": "P",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "314-286-2028",
"authorized_official_name_suffix": "II",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "261QP2300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Primary Care",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Dillon Plaza Family Medicine",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in High Ridge, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2008; 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.