MISSOURI IMAGING, INC (NPI# 1164480836) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164480836 |
| Entity Type | Organization |
| Organization Name | MISSOURI IMAGING, INC |
| Other Organization Name | BRIDGETON MRI & IMAGING CENTER, LLC |
| Practice Address |
12121 Saint Charles Rock Rd Bridgeton MO 63044-2602 |
| Mailing Address |
Po Box 934995 Atlanta GA 31193-4995 |
| Practice Telephone | 3142915050 |
| Practice Fax Number | 3142918209 |
| Mailing Telephone | 8666591211 |
| Mailing Fax Number | 3367741751 |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2009-12-01 |
| Authorized Official Name | MR. DANIEL J SCHAEFER (COO) |
| Authorized Official Telephone | 7703000101 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
MO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MEDICARE RR | 470000936 | 01 | |
| DOL | 610049400 | 01 | |
| AETNA | 7190102 | 01 | |
| MO | 717224307 | 05 | |
| MO | BCBS | 194035 | 01 |
| Other Name | Type Code |
|---|---|
| Bridgeton MRI & Imaging Center, LLC | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104884881 | Missouri Imaging, Inc | Radiology | 5905 Mexico Rd, St Peters, MO 63376-1613 | 2006-05-03 |
| 1578521241 | Missouri Imaging, Inc | Radiology | 473 S Kirkwood Rd, Kirkwood, MO 63122-6119 | 2006-05-03 |
| 1497713168 | Missouri Imaging, Inc | Radiology | 3065 William St, Suite 109, Cape Girardeau, MO 63703-6393 | 2006-05-03 |
| Street Address |
12121 SAINT CHARLES ROCK RD |
| City | BRIDGETON |
| State | MO |
| Zip Code | 63044-2602 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679877575 | Bridgeton Imaging, L.L.C. | Radiology | 12121 Saint Charles Rock Rd, Bridgeton, MO 63044-2602 | 2011-01-06 |
| 1518137603 | Sae R. Choi | Surgery | 12121 Saint Charles Rock Rd, Bridgeton, MO 63044-2602 | 2008-03-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073150017 | Zoe Marie Wadsworth | Nurse Practitioner | 12255 Depaul Dr Suite 300, Bridgeton, MO 63044 | 2019-12-10 |
| 1609412451 | Beyond Better, Best Home Health Care Services, Limited Liability Corpo | In Home Supportive Care | 3430 Mckelvey Road Ste B, Bridgeton, MO 63044 | 2019-11-26 |
| 1275189078 | Delicate Angels Home Health LLC | Home Health | 11726 St. Charles Rock Road Suite G, Bridgeton, MO 63044 | 2019-08-16 |
| 1588210082 | Nicholas Huber | Physical Therapist | 12349 Depaul Dr., Ste. 110, Bridgeton, MO 63044 | 2019-08-12 |
| 1124688858 | Michelle Bassett | Registered Nurse | 11520 St. Charles Rock Rd., Suite 106, Bridgeton, MO 63044 | 2019-06-14 |
| 1336703883 | Elena A Barrow | Nurse Practitioner | 12255 Depaul Dr, Suite 260, Bridgeton, MO 63044 | 2019-04-30 |
| 1487123105 | Laura N Steiner | Registered Nurse | Gateway Pediatrics, Ltd, 12255 Depaul Drive, Suite 460 North Medical Building, Bridgeton, MO 63044 | 2018-11-26 |
| 1205310950 | Danielle Mathis | Nurse Practitioner | 3440 Depaul Lane Suite 201, Bridgeton, MO 63044 | 2018-09-19 |
| 1588163570 | Thoughts Out Loud Counseling, LLC | Social Worker | 11520 St. Charles Rock Road Suite 101, Bridgeton, MO 63044 | 2018-02-06 |
| 1912411430 | Breanna Victoria Hayes | Counselor | 3165 Mckevley Road, Suite 200, Bridgeton, MO 63044 | 2017-11-20 |
| Find all providers in zip 63044 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174933022 | Clelland James-henry Chatman | Radiology | 12303 De Paul Dr, Bridgeton, MO 63044 | 2014-04-30 |
| 1679877575 | Bridgeton Imaging, L.L.C. | Radiology | 12121 Saint Charles Rock Rd, Bridgeton, MO 63044-2602 | 2011-01-06 |
| 1316954373 | Andre Strzembosz | Radiology | 12303 De Paul Dr, Depaul Health Center, Bridgeton, MO 63044-2512 | 2006-08-02 |
| 1891718987 | Karen J Baranski | Radiology | 12303 Depaul Dr, Depaul Health Center, Bridgeton, MO 63044 | 2006-07-26 |
| 1578597290 | Ronald L Palmer | Radiology | 12303 Depaul Dr, Depaul Health Center, Bridgeton, MO 63044 | 2006-07-10 |
| 1457383713 | Edwin C Ernst IIi | Radiology | 12303 Depaul Dr, Depaul Health Center, Bridgeton, MO 63044 | 2006-07-07 |
| 1750313094 | Matthew W Stadnyk | Radiology | 12303 Depaul Dr, Depaul Health Center, Bridgeton, MO 63044 | 2006-07-07 |
| 1457383796 | Megan M Gau | Radiology | 12303 Depaul Dr, Depaul Health Center, Bridgeton, MO 63044 | 2006-07-07 |
| 1629000971 | The Ernst Radiology Clinic, Inc | Radiology | 12303 Depaul Dr, Depaul Health Center, Bridgeton, MO 63044 | 2006-07-07 |
| 1992746937 | Robert J Gresick Jr. | Radiology | 12303 Depaul Dr, Depaul Health Center, Bridgeton, MO 63044 | 2006-06-09 |
| Find all providers in BRIDGETON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.