NPIMap

Organization Active NPI

Signature Medical Group, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Fenton, MO
National Provider Identifier
1942431606
Registry record updated Aug 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
SIGNATURE MEDICAL GROUP, INC.
Practice address
1011 Bowles Ave Ste 100
Fenton, MO 63026-2387
Phone
(314) 849-0311
Fax
(314) 849-4423
NPI assigned
Jul 29, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2024

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

Authorized official

Name
Chad Sackman
Title
Ceo
Phone
(314) 849-0311

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

1011 Bowles Ave Ste 100
Fenton, MO 63026-2387

Mailing address

12639 Old Tesson Rd
Suite 115
Saint Louis, MO 63128-2786
Phone (314) 849-0311

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930093833 MO DME Supplier - Physician - General Surgery 4880598291 Practice locations: Fenton, MO

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Premier Care Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 45

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 45

NPI Registry JSON

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

{
    "created_epoch": "1248825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723075200000",
    "number": "1942431606",
    "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": "1011 BOWLES AVE STE 100",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630262387",
            "telephone_number": "314-849-0311",
            "fax_number": "314-849-4423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIGNATURE MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-29",
        "last_updated": "2024-08-08",
        "certification_date": "2024-08-01",
        "status": "A",
        "authorized_official_last_name": "SACKMAN",
        "authorized_official_first_name": "CHAD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "314-849-0311"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fenton, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2024; 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.