Organization Active NPI

Albanna Neurosurgical Consultants a Professional Corp

  • Neurological Surgery Physician
  • Saint Louis, MO
National Provider Identifier
1811056005
Registry record updated Oct 26, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
Legal business name
ALBANNA NEUROSURGICAL CONSULTANTS A PROFESSIONAL CORP
Practice address
5000 Cedar Plaza Pkwy
Suite 220
St Louis, MO 63128
Phone
(314) 849-9090
Fax
(314) 849-4165
NPI assigned
Dec 6, 2006
Last updated
Oct 26, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2011

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

Authorized official

Name
Mrs. Chris Ketcherside, CMM
Title
Practice Adm Corp Sec
Phone
(314) 849-9090

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X
Neurological Surgery Physician 207T00000X Primary
Physical Medicine & Rehabilitation Physician 208100000X

Addresses

Primary practice location

5000 Cedar Plaza Pkwy
Suite 220
St Louis, MO 63128

Mailing address

5000 Cedar Plaza Pkwy
Suite 220
St Louis, MO 63128
Phone (314) 849-9090

Other identifiers 3

IdentifierTypeStateIssuer
508602802MedicaidMD
096K1OtherBCBS
3692OtherGHP

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1319587200000",
    "number": "1811056005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5000 CEDAR PLAZA PKWY",
            "address_2": "SUITE 220",
            "city": "ST LOUIS",
            "state": "MO",
            "postal_code": "63128",
            "telephone_number": "314-849-9090",
            "fax_number": "314-849-4165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5000 CEDAR PLAZA PKWY",
            "address_2": "SUITE 220",
            "city": "ST LOUIS",
            "state": "MO",
            "postal_code": "63128",
            "telephone_number": "314-849-9090",
            "fax_number": "314-849-4165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALBANNA NEUROSURGICAL CONSULTANTS A PROFESSIONAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-06",
        "last_updated": "2011-10-26",
        "status": "A",
        "authorized_official_last_name": "KETCHERSIDE",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_title_or_position": "PRACTICE ADM CORP SEC",
        "authorized_official_telephone_number": "314-849-9090",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CMM"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "508602802",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "096K1",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHP",
            "identifier": "3692",
            "state": null
        }
    ],
    "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 Oct 26, 2011; 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.