NPIMap

Organization Active NPI

Boonslick Medical Group Inc

  • Diagnostic Radiology Physician
  • Saint Charles, MO
National Provider Identifier
1972666162
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
BOONSLICK MEDICAL GROUP INC
Practice address
1301 Boones Lick Rd
Saint Charles, MO 63301-2463
Phone
(636) 916-8228
Fax
(636) 946-5774
NPI assigned
Dec 18, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Robert B Cusworth, MD
Title
President, Boonslick Med. Group Inc
Phone
(636) 947-3392

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X MO Primary

Addresses

Primary practice location

1301 Boones Lick Rd
Saint Charles, MO 63301-2463

Mailing address

1301 Boones Lick Rd
Saint Charles, MO 63301-2463
Phone (636) 916-8228

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1972666162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 BOONES LICK RD",
            "city": "SAINT CHARLES",
            "state": "MO",
            "postal_code": "633012463",
            "telephone_number": "636-916-8228",
            "fax_number": "636-946-5774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 BOONES LICK RD",
            "city": "SAINT CHARLES",
            "state": "MO",
            "postal_code": "633012463",
            "telephone_number": "636-916-8228",
            "fax_number": "636-946-5774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOONSLICK MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-18",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "CUSWORTH",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT, BOONSLICK MED. GROUP INC",
        "authorized_official_telephone_number": "636-947-3392",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Charles, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.