Organization Active NPI

Pepose Vision Institute, PC

  • Ophthalmology Physician
  • Chesterfield, MO
National Provider Identifier
1871529131
Registry record updated Nov 28, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
PEPOSE VISION INSTITUTE, PC
Practice address
1815 Clarkson Road
Chesterfield, MO 63017-5065
Phone
(636) 728-0111
Fax
(636) 728-0093
NPI assigned
Jun 25, 2006
Last updated
Nov 28, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2007

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

Authorized official

Name
Dr. Jay Stuart Pepose, M.D.NPI 1134111446
Title
Medical Director
Phone
(636) 728-0111

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X MO Primary

Addresses

Primary practice location

1815 Clarkson Road
Chesterfield, MO 63017-5065

Mailing address

1815 Clarkson Road
Chesterfield, MO 63017-5065
Phone (636) 728-0111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041118000245 MO Part B Supplier - Clinic/Group Practice 8628032729 Receives reassigned benefits from 8 practitioners
Practice locations: Chesterfield, MO; Saint Louis, MO

National Provider Directory

National Provider Directory

Locations

7530 Solutions Ctr
Chicago, IL 60677

1815 Clarkson Rd
Chesterfield, MO 63017
Phone (636) 728-0111

Practitioners & affiliated clinicians

Practitioners 9

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": "1151193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196208000000",
    "number": "1871529131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1815 CLARKSON ROAD",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630175065",
            "telephone_number": "636-728-0111",
            "fax_number": "636-728-0093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1815 CLARKSON ROAD",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630175065",
            "telephone_number": "636-728-0111",
            "fax_number": "636-728-0093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEPOSE VISION INSTITUTE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-25",
        "last_updated": "2007-11-28",
        "status": "A",
        "authorized_official_last_name": "PEPOSE",
        "authorized_official_first_name": "JAY",
        "authorized_official_middle_name": "STUART",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "636-728-0111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chesterfield, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.