Active NPI
Bryan Thomas Whitlow, M.D.
- Pain Medicine (Anesthesiology) Physician
- Bridgeton, MO
National Provider Identifier
1962856682
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pain Medicine (Anesthesiology) Physician
- License
- 2020038763
- Practice address
- 12255 De Paul Dr Ste 120
Bridgeton, MO 63044-2513 - Phone
- (314) 291-7900
- NPI assigned
- Apr 19, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 2018-00188 | NC | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Pain Medicine (Anesthesiology) Physician | 207LP2900X | 2020038763 | MO | Primary |
Addresses
Primary practice location
12255 De Paul Dr Ste 120
Bridgeton, MO 63044-2513
Mailing address
PO Box 955534
Saint Louis, MO 63195-5534
Other practice location 1
101 Manning Dr
Chapel Hill, NC 27514-4220
Phone (984) 974-1000
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | bwhitlow391778@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
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210430000438 | MO | Practitioner - Interventional Pain Management | 8921390477 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Interventional Pain Management
- Education
- Baylor College of Medicine, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1405 N Truman Blvd
Festus, MO 63028-1177
Phone (636) 933-2243
Hospital & facility affiliations
- Mercy Hospital Jefferson
- St Lukes Hospital
- Mercy Hospital St Louis
- Mercy Hospital South
- Madison Medical Center
- SSM Health Rehabilitation Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2018-00188 | NC | MD | Anesthesiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Interventional Pain Institute, LLC | Anesthesiology | Current | Accepting new patients |
| Interventional Pain Institute, LLC | Current | Accepting new patients | |
| Dreamy Time Inc | Past | Accepting new patients | |
| Interventional Pain Center of Chesterfield LLC | Past | Accepting new patients | |
| Key Anesthesia Partners | Past | Accepting new patients |
Locations
12255 De Paul Dr
Ste 120
Bridgeton, MO 63044
Phone (314) 344-7300
17300 North Outer 40 Rd
Ste 100
Chesterfield, MO 63005
Phone (314) 865-7992
500 Chesterfield Ctr
Ste 250
Chesterfield, MO 63017
Phone (636) 519-8889
1405 N Truman Blvd
Festus, MO 63028
Phone (314) 432-2329
721 S 5th St
Saint Charles, MO 63301
60 Business Park Dr
Ste A
Troy, MO 63379
Phone (636) 728-9460
Interoperability endpoints
- bwhitlow19681@ukhcdirect.org
Organizations & group practices 5
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Interventional Pain Medicine Physician
- Troy, MO
- NPI 1013779271
-
- Certified Registered Nurse Anesthetist
- Chesterfield, MO
- NPI 1770255168
-
- Ambulatory Surgical Clinic/Center
- Chesterfield, MO
- NPI 1922144484
-
- Certified Registered Nurse Anesthetist
- Chesterfield, MO
- NPI 1467073742
Hospital & facility affiliations 7
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Critical Access Hospital
- Fredericktown, MO
- NPI 1720163025
Hospital
-
- General Acute Care Hospital
- Saint Louis, MO
- NPI 1427098169
Hospital
-
- Rehabilitation Hospital
- Richmond Heights, MO
- NPI 1659511988
Inpatient rehabilitation facility
-
- General Acute Care Hospital
- Chesterfield, MO
- NPI 1346251543
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1461024000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1627257600000",
"number": "1962856682",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 955534",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631955534"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12255 DE PAUL DR STE 120",
"city": "BRIDGETON",
"state": "MO",
"postal_code": "630442513",
"telephone_number": "314-291-7900"
}
],
"practiceLocations": [
{
"address_1": "101 Manning Dr",
"address_purpose": "LOCATION",
"city": "Chapel Hill",
"state": "NC",
"postal_code": "275144220",
"country_code": "US",
"telephone_number": "984-974-1000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WHITLOW",
"first_name": "BRYAN",
"middle_name": "THOMAS",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-04-19",
"last_updated": "2021-07-26",
"certification_date": "2021-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "NC",
"license": "2018-00188",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "207LP2900X",
"taxonomy_group": "",
"desc": "Anesthesiology, Pain Medicine",
"state": "MO",
"license": "2020038763",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "bwhitlow391778@direct-ehr-ssmhc.com",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "bwhitlow391778@direct-ehr-ssmhc.com",
"address_1": "12255 De Paul Dr Ste 120",
"city": "Bridgeton",
"state": "MO",
"country_code": "US",
"postal_code": "630442513",
"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": "12255 De Paul Dr Ste 120",
"city": "Bridgeton",
"state": "MO",
"country_code": "US",
"postal_code": "630442513",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Bridgeton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.