Active NPI
Stephanie A Otis, M.D.
- Pediatric Orthopaedic Surgery Physician
- Saint Louis, MO
National Provider Identifier
1841226487
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Orthopaedic Surgery Physician
- License
- 106730
- Practice address
- 621 S New Ballas Rd
Suite 63B
Saint Louis, MO 63141-8232 - Phone
- (314) 983-4700
- Fax
- (314) 692-9862
- NPI assigned
- Jun 24, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | 106730 | MO | |
| Pediatric Orthopaedic Surgery Physician | 207XP3100X | 106730 | MO | Primary |
Addresses
Primary practice location
621 S New Ballas Rd
Suite 63B
Saint Louis, MO 63141-8232
Mailing address
12639 Old Tesson Rd
Suite 115
Saint Louis, MO 63128-2786
Phone (314) 849-0311
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0900169 | Other | MO | UNITED HEALTHCARE |
| 256445 | Other | MO | HEALTHLINK |
| 207688508 | Medicaid | MO | |
| 83380V3223 | Other | MO | GROUP HEALTHPLAN |
| 200030003 | Other | MO | RAILROAD MEDICARE |
| 4534390 | Other | MO | AETNA |
| 1598506001 | Other | MO | CIGNA |
| 24774 | Other | MO | BLUE CROSS BLUE SHIELD |
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 |
|---|---|---|---|
| 106730 | MO | MD | Orthopaedic Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151107200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1377648000000",
"number": "1841226487",
"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 63B",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631418232",
"telephone_number": "314-983-4700",
"fax_number": "314-692-9862"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OTIS",
"first_name": "STEPHANIE",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-24",
"last_updated": "2013-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "207X00000X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery",
"state": "MO",
"license": "106730",
"primary": false
},
{
"code": "207XP3100X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery, Pediatric Orthopaedic Surgery",
"state": "MO",
"license": "106730",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "0900169",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHLINK",
"identifier": "256445",
"state": "MO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "207688508",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GROUP HEALTHPLAN",
"identifier": "83380V3223",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "200030003",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4534390",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "1598506001",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "24774",
"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 Aug 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.