Active NPI
Thomas P Shaner, M.D.
- Obstetrics & Gynecology Physician
- Saint Louis, MO
National Provider Identifier
1760411359
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- 34683
- Practice address
- 621 S New Ballas Rd
Suite 695a
Saint Louis, MO 63141-8232 - Phone
- (314) 872-7400
- Fax
- (314) 872-9126
- NPI assigned
- Jul 3, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 34683 | MO | Primary |
Addresses
Primary practice location
621 S New Ballas Rd
Suite 695a
Saint Louis, MO 63141-8232
Mailing address
12639 Old Tesson Rd
Suite 115
Saint Louis, MO 63128-2786
Phone (314) 849-0311
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 112118 | Other | MO | BLUE CROSS BLUE SHIELD |
| 122339 | Other | MO | HEALTHLINK |
| 4272667 | Other | MO | AETNA |
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 |
|---|---|---|---|
| 34683 | MO | MD | Obstetrics & Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ozarks Medical Center | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- General Acute Care Hospital
- West Plains, MO
- NPI 1831115641
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151884800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1760411359",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12639 OLD TESSON RD",
"address_2": "SUITE 115",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631282786",
"telephone_number": "314-849-0311",
"fax_number": "314-849-4423"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "621 S NEW BALLAS RD",
"address_2": "SUITE 695A",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631418232",
"telephone_number": "314-872-7400",
"fax_number": "314-872-9126"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHANER",
"first_name": "THOMAS",
"middle_name": "P",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "MO",
"license": "34683",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "112118",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHLINK",
"identifier": "122339",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4272667",
"state": "MO"
}
],
"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 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.