DR. HAROLD KENNETH GILBERTSON, DC - NPI NUMBER 1124028998

Summary

Provider Name: DR. HAROLD KENNETH GILBERTSON, DC

NPI Number: 1124028998

Clasification: Technician, Other (247200000X)

Organization: ADVANTAGE PAIN MANAGEMENT INC

Address:
11903 ST. CHARLES ROCK RD.
ADVANTAGE PAIN MANAGEMENT
BRIDGETON, MO
ZIP 63044

Phone Number: (314) 739-2900



Detailed Information

DR. Harold Kenneth Gilbertson, DC is a technician in Bridgeton, MO with 43 years of experience. The provider is a collective term for persons with specialized training in various narrow fields of expertise whose occupations require training and skills in specific technical processes and procedures; and where further classification is deemed unnecessary by the user. The assigned NPI number for this provider is 1124028998 and is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: LOGAN COLLEGE OF CHIROPRACTIC
Graduation Year: 1972

The provider's business address is:

11903 ST. CHARLES ROCK RD.
ADVANTAGE PAIN MANAGEMENT
BRIDGETON, MO
ZIP 63044-623
Phone: (314) 739-2900
Fax: (314) 770-1623

The enumeration date for this NPI number is 7/22/2005 and was last updated on 9/26/2012.

Map - Location of Practice

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1497090567 TIFFANY MITCHELL
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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 247200000X Technician, Other No
2 111N00000X Chiropractor 003647 MO Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 MA1995001 MEDICARE UPIN
2 MA1995001 MEDICARE PIN
3 T89731 MEDICARE UPIN
4 990001637 MEDICARE ID-TYPE UNSPECIFIED MO

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1124028998 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 1 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Provider Last Name Legal Name GILBERTSON The last name of the provider. If the provider is an individual, this is the legal name.
4 Provider First Name HAROLD The first name of the provider, if the provider is an individual.
5 Provider Middle Name KENNETH The middle name of the provider, if the provider is an individual.
6 Provider Name Prefix Text DR. The name prefix or salutation of the provider if the provider is an individual; for example, Mr., Mrs., or Corporal.
7 Provider Credential Text DC The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
8 Provider First Line Business Practice Location Address 11903 ST. CHARLES ROCK RD. The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
9 Provider Second Line Business Practice Location Address ADVANTAGE PAIN MANAGEMENT The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
10 Provider Business Practice Location Address City Name BRIDGETON The city name in the location address of the provider being identified.
11 Provider Business Practice Location Address State Name MO The State code in the location of the provider being identified.
12 Provider Business Practice Location Address Postal Code 630442623 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
13 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
14 Provider Business Practice Location Address Telephone Number 3147392900 The telephone number associated with the location address of the provider being identified.
15 Provider Business Practice Location Address Fax Number 3147701623 The fax number associated with the location address of the provider being identified.
16 Provider Enumeration Date 7/22/2005 The date the provider was assigned a unique identifier (assigned an NPI).
17 Last Update Date 9/26/2012 The date that a record was last updated or changed.
18 Provider Gender Code M The code designating the provider’s gender if the provider is a person.
19 Healthcare Provider Taxonomy Code 1 247200000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
20 Healthcare Provider Primary Taxonomy Switch 1 N
21 Healthcare Provider Taxonomy Code 2 111N00000X
22 Provider License Number 2 003647 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
23 Provider License Number State Code 2 MO The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
24 Healthcare Provider Primary Taxonomy Switch 2 Y
25 Other Provider Identifier 1 MA1995001 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
26 Other Provider Identifier Type Code 1 02 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
27 Other Provider Identifier 2 MA1995001 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
28 Other Provider Identifier Type Code 2 08 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
29 Other Provider Identifier 3 T89731 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
30 Other Provider Identifier Type Code 3 02 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
31 Other Provider Identifier 4 990001637 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
32 Other Provider Identifier Type Code 4 04 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
33 Other Provider Identifier State 4 MO
34 Is Sole Proprietor N Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No

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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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