SIGNATURE MEDICAL GROUP, INC (NPI# 1871542761) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871542761 |
| Entity Type | Organization |
| Organization Name | SIGNATURE MEDICAL GROUP, INC |
| Practice Address |
12639 Old Tesson Rd Suite 115 Saint Louis MO 63128-2786 |
| Practice Telephone | 3148490311 |
| Practice Fax Number | 3148494423 |
| Mailing Telephone | 3148490311 |
| Mailing Fax Number | 3148494423 |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2013-04-08 |
| Authorized Official Name | MR. JAN C VEST (CEO) |
| Authorized Official Telephone | 3148428655 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207KA0200X |
Allergy & Immunology Specialization: Allergy |
Allopathic & Osteopathic Physicians | ||
| N | 207V00000X | Obstetrics & Gynecology | Allopathic & Osteopathic Physicians | ||
| N | 2081P2900X |
Physical Medicine & Rehabilitation Specialization: Pain Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 208C00000X | Colon & Rectal Surgery | MO | Allopathic & Osteopathic Physicians | |
| N | 207N00000X | Dermatology | MO | Allopathic & Osteopathic Physicians | |
| N | 207T00000X | Neurological Surgery | MO | Allopathic & Osteopathic Physicians | |
| N | 207VX0201X |
Obstetrics & Gynecology Specialization: Gynecologic Oncology |
MO | Allopathic & Osteopathic Physicians | |
| N | 208000000X | Pediatrics | MO | Allopathic & Osteopathic Physicians | |
| N | 208600000X | Surgery | MO | Allopathic & Osteopathic Physicians | |
| N | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
MO | Allopathic & Osteopathic Physicians | |
| Y | 207X00000X | Orthopaedic Surgery | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | GROUP HEALTH PLAN | 3223 | 01 |
| MO | AETNA | 7217344 | 01 |
| MO | RAILROAD MEDICARE | CY0091 | 01 |
| MO | HEALTHLINK | 377225 | 01 |
| MO | 501357701 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235430851 | Signature Medical Group, Inc | Family Medicine | 2010 S Arlington Heights Rd Ste 110, Arlington Heights, IL 60005-4100 | 2010-11-12 |
| 1255513784 | Signature Medical Group, Inc | Durable Medical Equipment & Medical Supplies | 12777 De Paul Drive, Suite 305, Bridgeton, MO 63044 | 2007-11-27 |
| 1992998256 | Signature Medical Group, Inc | Durable Medical Equipment & Medical Supplies | 20 Progress Point Parkway, Suite 106, O Fallon, MO 63368 | 2007-08-21 |
| 1609269919 | Signature Medical Group, Inc | Durable Medical Equipment & Medical Supplies | 5301 Veterans Memorial Pkwy, Suite 104, Saint Peters, MO 63376-2298 | 2015-03-11 |
| 1073904769 | Signature Medical Group, Inc | Durable Medical Equipment & Medical Supplies | 9323 Phoenix Village Pkwy, O Fallon, MO 63368-4281 | 2015-02-17 |
| 1023435534 | Signature Medical Group, Inc | Durable Medical Equipment & Medical Supplies | 7345 Watson Rd, Suite Ll3, Saint Louis, MO 63119-4405 | 2014-03-21 |
| 1396907614 | Signature Medical Group, Inc | Durable Medical Equipment & Medical Supplies | 1165 N Butterfield Rd, Bolivar, MO 65613-1056 | 2008-06-27 |
| 1255477469 | Signature Medical Group, Inc | Durable Medical Equipment & Medical Supplies | 1027 Bellevue Ave, Suite 25, Saint Louis, MO 63117-1851 | 2007-01-29 |
| 1124164942 | Signature Medical Group, Inc | Durable Medical Equipment & Medical Supplies | 621 S New Ballas Rd, Suite 63b, Saint Louis, MO 63141-8232 | 2007-01-29 |
| 1649201864 | Signature Medical Group, Inc | Durable Medical Equipment & Medical Supplies | 12639 Old Tesson Rd, Suite 115, Saint Louis, MO 63128-2786 | 2006-07-05 |
| Street Address |
12639 OLD TESSON RD SUITE 115 |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63128-2786 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831191014 | Jeremy D Dunbarr | Physician Assistant | 12639 Old Tesson Rd, Suite 115, Saint Louis, MO 63128-2786 | 2005-06-01 |
| 1558978403 | Christopher Scott Thaller | Physical Therapist | 12639 Old Tesson Rd, Saint Louis, MO 63128-2711 | 2020-09-24 |
| 1225652514 | Erica Nicole Reeg | Nurse Practitioner | 12639 Old Tesson Rd, Saint Louis, MO 63128-2711 | 2020-06-02 |
| 1356615538 | Shayna Leigh Laramore | Nurse Practitioner | 12639 Old Tesson Rd, Suite, Saint Louis, MO 63128-2786 | 2012-03-06 |
| 1467729988 | Signature Medical Grou P of Kc, P.a. | Durable Medical Equipment & Medical Supplies | 12639 Old Tesson Rd, Suite 115, Saint Louis, MO 63128-2786 | 2011-11-29 |
| 1477876415 | Meghan C Flynn | Physician Assistant | 12639 Old Tesson Rd, Suite 115, Saint Louis, MO 63128-2786 | 2010-03-04 |
| 1376789362 | Dana Kay Mcquade | Physical Therapy Assistant | 12639 Old Tesson Rd, Suite 120, Saint Louis, MO 63128-2786 | 2008-12-23 |
| 1114171535 | Medical Implant Sloutions, LLC | Durable Medical Equipment & Medical Supplies | 12639 Old Tesson Rd, 116, Saint Louis, MO 63128-2786 | 2008-11-12 |
| 1154572170 | Signature Healthcare Foundation | Durable Medical Equipment & Medical Supplies | 12639 Old Tesson Rd, Suite 120, Saint Louis, MO 63128-2786 | 2008-10-08 |
| 1396991436 | Meghan D Sinon | Physician Assistant | 12639 Old Tesson Rd, Suite 115, Saint Louis, MO 63128-2786 | 2008-08-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235771155 | James T Fetsch Dmd LLC | Dentist | 10004 Kennerly Rd Suite 240, Saint Louis, MO 63128 | 2019-10-11 |
| 1326504655 | Nikodem Dental Holdings | Dentist | 4337 Butler Hill Rd Suite G, St Louis Mo, MO 63128 | 2019-02-12 |
| 1932678505 | Michelle Anne Arvidson | Physical Therapy Assistant | Elite Physical Therapy, 12608 Lamplighter Square Shopping Center, St. Louis, MO 63128 | 2018-11-13 |
| 1245726710 | Kristen Rider | Nurse Practitioner | 9964 Kennerly Rd Ste D, Saint Louis, MO 63128 | 2018-07-07 |
| 1306217427 | Sophia Bednarski | Dentist | 12660 Lamplighter Square Shopping Center, St. Louis, MO 63128 | 2015-10-15 |
| 1427434224 | Darcie Burrus | Counselor | 12523 Old Tesson Rd G, St Louis, MO 63128 | 2015-08-04 |
| 1710368584 | Sara Hawatmeh | Internal Medicine | 12345 W Bend Dr Ste 304, Saint Louis, MO 63128 | 2015-06-17 |
| 1871989590 | Celia Grace Montes-kolence | Speech-Language Pathologist | 12335 W Bend Drive, Saint Louis, MO 63128 | 2015-04-09 |
| 1245629302 | Marius Antonio Evans | Dentist | 9911 Kennerly Rd., Suite G, St. Louis, MO 63128 | 2015-01-13 |
| 1801230313 | Sarah Elizabeth Walsh | Emergency Medicine | 10010 Kennerly Road, Emergency Department, St. Anthony's Medical Center, St. Louis, MO 63128 | 2013-04-26 |
| Find all providers in zip 63128 | ||||
| Taxonomy Code | 207X00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. American Osteopathic Board of Orthopaedic Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Orthopaedic Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760903850 | Adam J Martin | Orthopaedic Surgery | 621 S New Ballas Rd Ste 3005b, Saint Louis, MO 63141-8266 | 2017-06-29 |
| 1801254164 | St. Anthony's Physician Organization | Orthopaedic Surgery | 12700 Southfork Rd Ste 100, Saint Louis, MO 63128-3201 | 2016-02-02 |
| 1285051482 | Michael Joseph Reiter | Orthopaedic Surgery | 3009 N Ballas Rd Ste 269c, Saint Louis, MO 63131-2339 | 2014-03-25 |
| 1154767507 | Robert M Corey | Orthopaedic Surgery | 3635 Vista Ave, 7th Floor- Desloge Tower, Department of Orthopedics, Saint Louis, MO 63110 | 2013-05-13 |
| 1770855884 | George Owens Sertl | Orthopaedic Surgery | 10757 Forest Path Dr, Saint Louis, MO 63128-2008 | 2012-02-04 |
| 1285881581 | John Powell Arnot | Orthopaedic Surgery | 1145 Lockett Rd, Saint Louis, MO 63131-4234 | 2008-08-19 |
| 1558526327 | Jordan Howard Ginsburg | Orthopaedic Surgery | 231 S Bemiston Ave, Suite 500, Saint Louis, MO 63105-1914 | 2008-07-22 |
| 1659562528 | Kenyatta D Norman | Orthopaedic Surgery | 1209 Washington Ave, Ste 518, Saint Louis, MO 63103-1996 | 2007-08-06 |
| 1134342918 | Matthew Walter Bradley | Orthopaedic Surgery | 1001 S Kirkwood Rd Ste 120, Saint Louis, MO 63122-7250 | 2007-04-10 |
| 1437272663 | St. Louis-clayton Orthopedic Group, Inc. | Orthopaedic Surgery | 1034 S Brentwood Blvd Ste 650, Saint Louis, MO 63117-1267 | 2007-04-10 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63128 |
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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.