NPIMap

Individual provider Active NPI

Marc Bruce Abrams, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Creve Coeur, MO
National Provider Identifier
1720144678
Registry record updated Aug 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
11777 Issued in MO
Practice address
456 N New Ballas Rd
Suite 249
Creve Coeur, MO 63141-6831
Phone
(314) 569-2201
Fax
(314) 569-2320
NPI assigned
Dec 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 11777 MO Primary

Addresses

Primary practice location

456 N New Ballas Rd
Suite 249
Creve Coeur, MO 63141-6831

Mailing address

456 N New Ballas Rd
Suite 249
Creve Coeur, MO 63141-6831
Phone (314) 569-2201

Other identifiers 3

IdentifierTypeStateIssuer
111519OtherMOCIGNA HMO
29075OtherMOBCBS
T80996OtherMOMEDICARE ID- TYPE UNSPECIFIED DR ABRAMS

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
11777MOMDOral and Maxillofacial Surgery (Dentist)

Practice roles

OrganizationSpecialtyStatusNew patients
William a. Gray, D.M.D., LLC Oral and Maxillofacial Surgery Past Accepting new patients
Oral and Maxillofacial Surgeons Inc Oral and Maxillofacial Surgery Past Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1218585600000",
    "number": "1720144678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "456 N NEW BALLAS RD",
            "address_2": "SUITE 249",
            "city": "CREVE COEUR",
            "state": "MO",
            "postal_code": "631416831",
            "telephone_number": "314-569-2201",
            "fax_number": "314-569-2320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "456 N NEW BALLAS RD",
            "address_2": "SUITE 249",
            "city": "CREVE COEUR",
            "state": "MO",
            "postal_code": "631416831",
            "telephone_number": "314-569-2201",
            "fax_number": "314-569-2320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABRAMS",
        "first_name": "MARC",
        "middle_name": "BRUCE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-28",
        "last_updated": "2008-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MO",
            "license": "11777",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA HMO",
            "identifier": "111519",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "29075",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID- TYPE UNSPECIFIED DR ABRAMS",
            "identifier": "T80996",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Creve Coeur, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.