Active NPI
Bruce C Weldon, MD
- Anesthesiology Physician
- Saint Louis, MO
National Provider Identifier
1962586834
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- R9977
- Practice address
- 1465 S Grand Blvd
Saint Louis, MO 63104-1003 - Phone
- (314) 678-3044
- NPI assigned
- Oct 25, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | R9977 | MO | Primary |
| Anesthesiology Physician | 207L00000X | T02084 | NC |
Addresses
Primary practice location
1465 S Grand Blvd
Saint Louis, MO 63104-1003
Mailing address
PO Box 843966
Kansas City, MO 64184-3966
Phone (573) 884-3300
Other practice location 1
404 N Keene St
Columbia, MO 65201-6626
Phone (573) 882-2568
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 89135X5 | Medicaid | NC |
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | bweldon297407@direct-ehr-ssmhc.com | Direct | |
| FHIR URL | https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ | Other |
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 |
|---|---|---|---|
| R9977 | MO | MD | Anesthesiology Physician |
| T02084 | NC | MD | Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161734400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1617062400000",
"number": "1962586834",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 843966",
"city": "KANSAS CITY",
"state": "MO",
"postal_code": "641843966",
"telephone_number": "573-884-3300",
"fax_number": "573-884-0943"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1465 S GRAND BLVD",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631041003",
"telephone_number": "314-678-3044"
}
],
"practiceLocations": [
{
"address_1": "404 N Keene St",
"address_purpose": "LOCATION",
"city": "Columbia",
"state": "MO",
"postal_code": "652016626",
"country_code": "US",
"telephone_number": "573-882-2568",
"fax_number": "573-882-2226",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WELDON",
"first_name": "BRUCE",
"middle_name": "C",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-25",
"last_updated": "2021-03-30",
"certification_date": "2021-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "MO",
"license": "R9977",
"primary": true
},
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "NC",
"license": "T02084",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "89135X5",
"state": "NC"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "bweldon297407@direct-ehr-ssmhc.com",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "bweldon297407@direct-ehr-ssmhc.com",
"address_1": "1465 S Grand Blvd",
"city": "Saint Louis",
"state": "MO",
"country_code": "US",
"postal_code": "631041003",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
"affiliation": "N",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "FHIR API",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "CCD",
"address_1": "1465 S Grand Blvd",
"city": "Saint Louis",
"state": "MO",
"country_code": "US",
"postal_code": "631041003",
"country_name": "United States",
"address_type": "DOM"
}
],
"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 Mar 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.