Active NPI
Blaire Lori Anderson, MD
- Surgery Physician
- St Louis, MO
National Provider Identifier
1962926311
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 2017021157
- Practice address
- 4921 Parkview Place Ste 8C
St Louis, MO 63110 - Phone
- (314) 747-1369
- Fax
- (314) 367-1943
- NPI assigned
- Jul 27, 2017
- Reactivated
- Mar 6, 2018
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 2017021157 | MO | Primary |
Addresses
Primary practice location
4921 Parkview Place Ste 8C
St Louis, MO 63110
Mailing address
PO Box 2932
Alberta, CANADA T1P1L5
CA
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2017021157 | MO | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1501113600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1520294400000",
"number": "1962926311",
"addresses": [
{
"country_code": "CA",
"country_name": "Canada",
"address_purpose": "MAILING",
"address_type": "FGN",
"address_1": "PO BOX 2932",
"city": "ALBERTA",
"state": "CANADA",
"postal_code": "T1P1L5"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4921 PARKVIEW PLACE STE 8C",
"city": "ST LOUIS",
"state": "MO",
"postal_code": "63110",
"telephone_number": "314-747-1369",
"fax_number": "314-367-1943"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "BLAIRE",
"middle_name": "LORI",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-07-27",
"last_updated": "2018-03-06",
"deactivation_date": "2018-03-01",
"reactivation_date": "2018-03-06",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "MO",
"license": "2017021157",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2018; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.