Individual provider Active NPI

Igor Brondz, M.D.

  • Obstetrics & Gynecology Physician
  • Saint Charles, MO
National Provider Identifier
1750341152
Registry record updated Oct 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
103336 Issued in MO
Practice address
400 1St Capitol Dr Ste 201
Saint Charles, MO 63301-2882
Phone
(636) 669-2332
Fax
(636) 669-2401
NPI assigned
Mar 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 103336 MO Primary

Addresses

Primary practice location

400 1St Capitol Dr Ste 201
Saint Charles, MO 63301-2882

Mailing address

PO Box 955534
Saint Louis, MO 63195-3539

Other identifiers 1

IdentifierTypeStateIssuer
209782705MedicaidMO

Electronic endpoints 2

TypeEndpointUseAffiliation
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other
Direct Messaging Address ibrondz10545@direct-ehr-ssmhc.com Direct

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
I20100818000328 MO Practitioner - Obstetrics/Gynecology 7618001280 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Other, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SSM Medical Group IncGroup PAC ID 6608776299, 565 clinicians

Practice addresses (Care Compare)

400 1St Capitol Dr
Suite 201
Saint Charles, MO 63301-2882
Phone (636) 669-2332

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
SSM Medical Group, Inc. CurrentSince Aug 1, 2018 Accepting new patients
Betty Jean Kerr People'S Health Centers CurrentSince Aug 31, 2022 Accepting new patients
Betty Jean Kerr People'S Health Centers CurrentSince Aug 31, 2022 Accepting new patients
SSM Health Care St. Louis Obstetrics & Gynecology Past Accepting new patients

Locations

3221 McKelvey Rd
Ste 301
Bridgeton, MO 63044

400 1st Capitol Dr
Ste 201
Saint Charles, MO 63301
Phone (636) 379-6363

1035 Bellevue Ave
Ste 500
Saint Louis, MO 63117
Phone (314) 647-1115

5701 Delmar Blvd
Saint Louis, MO 63112
Phone 31436778481248

Interoperability endpoints

  • Direct secure messaging: ibrondz10545@direct-ehr-ssmhc.com

Organizations & group practices 4

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 1

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": "1143504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603152000000",
    "number": "1750341152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 955534",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631953539"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 1ST CAPITOL DR STE 201",
            "city": "SAINT CHARLES",
            "state": "MO",
            "postal_code": "633012882",
            "telephone_number": "636-669-2332",
            "fax_number": "636-669-2401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRONDZ",
        "first_name": "IGOR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-28",
        "last_updated": "2020-10-20",
        "certification_date": "2020-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MO",
            "license": "103336",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "209782705",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "400 1st Capitol Dr Ste 201",
            "city": "Saint Charles",
            "state": "MO",
            "country_code": "US",
            "postal_code": "633012882",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ibrondz10545@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "ibrondz10545@direct-ehr-ssmhc.com",
            "address_1": "400 1st Capitol Dr Ste 201",
            "city": "Saint Charles",
            "state": "MO",
            "country_code": "US",
            "postal_code": "633012882",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Charles, MO

Sources for this page

Verify at the official NPI Registry.