Individual provider Active NPI

Ebunoluwa Ewere Otegbeye, MD

  • Surgery Physician
  • Saint Louis, MO
National Provider Identifier
1720508666
Registry record updated Aug 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
2019021293 Issued in MO
Practice address
1008 S Spring Ave
Saint Louis, MO 63110-2520
Phone
(314) 977-3530
NPI assigned
Jun 21, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 2019021293 MO Primary

Addresses

Primary practice location

1008 S Spring Ave
Saint Louis, MO 63110-2520

Mailing address

1008 S Spring Ave
Saint Louis, MO 63110-2520

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
I20250715002744 MO Practitioner - Colorectal Surgery (Proctology) 2365714136 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Colorectal Surgery (Proctology)
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SSM Health Care GroupGroup PAC ID 0143608372, 929 clinicians

Practice addresses (Care Compare)

1201 S Grand Blvd
Saint Louis, MO 63104-1016
Phone (314) 617-2000

Hospital & facility affiliations

  • SSM Health St Mary'S Hospital - St Louis Hospital, Saint Louis, MO, CCN 260091
  • SSM St Clare Health Center Hospital, Fenton, MO, CCN 260081
  • SSM Health Saint Louis University Hospital Hospital, Saint Louis, MO, CCN 260105

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2019021293MOMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
SSM Health Care Group CurrentSince Jul 1, 2025 Accepting new patients
SSM Health Care Group Surgery CurrentSince Jul 1, 2025 Accepting new patients
SSM Medical Group Inc. Past Accepting new patients

Locations

6420 Clayton Rd
Saint Louis, MO 63117
Phone (314) 768-8442

1201 S Grand Blvd
Saint Louis, MO 63104
Phone (314) 257-8222

10101 Woodfield Ln
Saint Louis, MO 63132
Phone (608) 280-4647

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1498003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754352000000",
    "number": "1720508666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1008 S SPRING AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631102520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1008 S SPRING AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631102520",
            "telephone_number": "314-977-3530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTEGBEYE",
        "first_name": "EBUNOLUWA",
        "middle_name": "EWERE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-21",
        "last_updated": "2025-08-05",
        "certification_date": "2025-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MO",
            "license": "2019021293",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.