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DR. BROCK DAVIS RIDENOUR MD
NPI 1164536710
Surgery - Plastic and Reconstructive Surgery in Saint Louis, MO

Active since August 19, 2006Opted out of Medicare · through Feb 27, 2027
12460 OLIVE BLVD, SUITE 202, SAINT LOUIS, MO 63141(314) 909-1202(314) 909-1290 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Brock Davis Ridenour Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. BROCK DAVIS RIDENOUR MD (NPI 1164536710) is an individual plastic and reconstructive surgery provider in Saint Louis, Missouri, licensed in Missouri (101951) and active in the NPI registry since August 2006. He has opted out of Medicare through February 27, 2027 and remains eligible to order and refer.

NPPES Registry Identity

NPI1164536710
Entity TypeIndividualMale
Primary Taxonomy2086S0122X
Provider Legal NameDR. BROCK DAVIS RIDENOURCredential: MD
Location Address12460 OLIVE BLVD, SUITE 202Saint Louis, MO 63141-6409
Mailing Address12460 Olive Blvd, Suite 202Saint Louis, MO 63141-6409 · (314) 909-1202 · Fax (314) 909-1290
Phone(314) 909-1202
Fax(314) 909-1290
Sole ProprietorYes
Enumeration DateAugust 19, 2006
Last NPPES UpdateJuly 8, 2007
✔ NPI 1164536710 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySurgery · Plastic and Reconstructive SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code2086S0122X
License✔ Licensed in MO · 101951
Definition
A surgeon who specializes in plastic and reconstructive surgery.
12460 OLIVE BLVD, Saint Louis, MO 63141
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Other Identifiers 1

Medicare UPINE10678MO

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Brock Davis Ridenour Md has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from February 27, 2017 through February 27, 2027.

Opt-Out Effective DateFebruary 27, 2017
Opt-Out In Effect ThroughFebruary 27, 2027Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Brock Ridenour's NPI number?

The NPI number for Brock Ridenour is 1164536710. It was assigned to this individual provider in the NPPES registry on August 19, 2006.

Where is Brock Ridenour located?

Brock Ridenour practices at 12460 Olive Blvd Suite 202, Saint Louis, MO 63141. The listed phone number is (314) 909-1202.

What is Brock Ridenour's specialty?

The primary specialty registered for this NPI is Surgery, specializing in Plastic and Reconstructive Surgery, with taxonomy code 2086S0122X.

Is Brock Ridenour enrolled in Medicare?

No. Brock Ridenour has opted out of Medicare through February 27, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Brock Ridenour was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.