| Washington University, Department Of Psychiatry | |
|
660 S Euclid Ave Saint Louis MO 63110-1010 | |
| (314) 362-5184 | |
| (314) 362-9999 |
| Full Name | Washington University, Department Of Psychiatry |
|---|---|
| Speciality | Clinic/Center |
| Location | 660 S Euclid Ave, Saint Louis, Missouri |
| Authorized Official Name and Position | Cathy L Eghigian (DIRECTOR, MANAGED CARE) |
| Authorized Official Contact | 3142730770 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Washington University, Department Of Psychiatry 7425 Forsyth Blvd Campus Box 8221 Saint Louis MO 63105-2171 Ph: (314) 935-0770 | Washington University, Department Of Psychiatry 660 S Euclid Ave Saint Louis MO 63110-1010 Ph: (314) 362-5184 |
| NPI Number | 1003856592 |
|---|---|
| Provider Enumeration Date | 06/07/2006 |
| Last Update Date | 10/30/2020 |
| Medicare PECOS PAC ID | 9830008770 |
|---|---|
| Medicare Enrollment ID | O20031211000237 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003856592 | NPI | - | NPPES |
| 610916400 | Other | MO | DEPARTMENT OF LABOR |
| 552990905 | Medicaid | MO | |
| 15-01999 | Other | MO | UHC GROUP NUMBER |
| 9049 | Other | MO | GHP MASTER VENDOR |
| 92215225 | Other | IL | BLUE SHIELD |
| 673341 | Other | MO | AETNA HMO GROUP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Bryan N Sewing |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1083798466 PECOS PAC ID: 6002808730 Enrollment ID: I20040401000676 |
| Provider Name | Angela M Reiersen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1790701928 PECOS PAC ID: 4981677739 Enrollment ID: I20040818001252 |
| Provider Name | Thomas F Richardson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1922025485 PECOS PAC ID: 2163490004 Enrollment ID: I20040920000444 |
| Provider Name | Li Shiun Chen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1386658003 PECOS PAC ID: 2860452794 Enrollment ID: I20041015000011 |
| Provider Name | Monica Elane Bishop |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1225055726 PECOS PAC ID: 3779540968 Enrollment ID: I20041220000654 |
| Provider Name | Theresa J Villaflores |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1609923689 PECOS PAC ID: 7517916653 Enrollment ID: I20050117000013 |
| Provider Name | Ginger E Nicol |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1285709980 PECOS PAC ID: 2668422866 Enrollment ID: I20050126000015 |
| Provider Name | John N Constantino |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1700804408 PECOS PAC ID: 9436100260 Enrollment ID: I20050209000161 |
| Provider Name | Mini Tandon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1972654358 PECOS PAC ID: 0446298459 Enrollment ID: I20050420000918 |
| Provider Name | John R Pruett |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1134146632 PECOS PAC ID: 1254367949 Enrollment ID: I20050714000006 |
| Provider Name | Mina Charepoo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1578682142 PECOS PAC ID: 6709810070 Enrollment ID: I20050926000794 |
| Provider Name | Daniel T Mamah |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1104842418 PECOS PAC ID: 5799710661 Enrollment ID: I20050929000048 |
| Provider Name | Jose Mathews |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1760400295 PECOS PAC ID: 1951336403 Enrollment ID: I20051004000111 |
| Provider Name | Elizabeth M Judd |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629021597 PECOS PAC ID: 8628099447 Enrollment ID: I20051208000409 |
| Provider Name | Kevin J Black |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1558389007 PECOS PAC ID: 7214943786 Enrollment ID: I20060222000086 |
| Provider Name | Joan Luby |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1477579696 PECOS PAC ID: 7719993963 Enrollment ID: I20060227000266 |
| Provider Name | Stephen L Ristvedt |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1528003258 PECOS PAC ID: 2466456850 Enrollment ID: I20060825000333 |
| Provider Name | Barry A Hong |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1831126218 PECOS PAC ID: 2567466907 Enrollment ID: I20060828000108 |
| Provider Name | Cheryl A Richards |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1326074253 PECOS PAC ID: 7618971888 Enrollment ID: I20060830000175 |
| Provider Name | Marcia J Mccabe |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1013944784 PECOS PAC ID: 2264431725 Enrollment ID: I20061211000129 |
| Provider Name | Suzanne Lecuyer |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1457461485 PECOS PAC ID: 8820189699 Enrollment ID: I20070808000343 |
| Provider Name | Eric J Lenze |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619941846 PECOS PAC ID: 1759460884 Enrollment ID: I20080430000808 |
| Provider Name | Charles R Conway |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1497771356 PECOS PAC ID: 5395824353 Enrollment ID: I20080502000306 |
| Provider Name | Tahir Rahman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1508892126 PECOS PAC ID: 2062571235 Enrollment ID: I20081111000669 |
| Provider Name | Melissa A Harbit |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1295751410 PECOS PAC ID: 4981769122 Enrollment ID: I20090223000178 |
| Provider Name | Sarah M Hartz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1922216829 PECOS PAC ID: 5698826030 Enrollment ID: I20090625000299 |
| Provider Name | Michele L Pergadia |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1114253952 PECOS PAC ID: 9638204993 Enrollment ID: I20100312000159 |
| Provider Name | Dragan M Svrakic |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1295751436 PECOS PAC ID: 4688703283 Enrollment ID: I20100519000845 |
| Provider Name | Michael R Jarvis |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1801814223 PECOS PAC ID: 1658400254 Enrollment ID: I20100519000867 |
| Provider Name | Nuri B Farber |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1487672804 PECOS PAC ID: 1557490166 Enrollment ID: I20100519000884 |
| Provider Name | Charles F Zorumski |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1851317077 PECOS PAC ID: 0042116873 Enrollment ID: I20100520000040 |
| Provider Name | Elliot C Nelson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1932127404 PECOS PAC ID: 7517096985 Enrollment ID: I20100522000150 |
| Provider Name | Cynthia E Rogers |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1497824965 PECOS PAC ID: 1951433572 Enrollment ID: I20100717000232 |
| Provider Name | Laura J Bierut |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1750307070 PECOS PAC ID: 1254456833 Enrollment ID: I20100920000842 |
| Provider Name | Shannon N Lenze |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1447553441 PECOS PAC ID: 8123202835 Enrollment ID: I20110405000094 |
| Provider Name | Donald D Bohnenkamp |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1316139116 PECOS PAC ID: 4082892740 Enrollment ID: I20110628000326 |
| Provider Name | Timothy E Spiegel |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1447421854 PECOS PAC ID: 9537337282 Enrollment ID: I20110722000563 |
| Provider Name | Neha Kirtane |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1295027704 PECOS PAC ID: 7719155159 Enrollment ID: I20110729000329 |
| Provider Name | Akinkunle Owoso |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1063610319 PECOS PAC ID: 7012186281 Enrollment ID: I20110803000805 |
| Provider Name | Lucia Del Pilar Cristancho Pimiento |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1366508145 PECOS PAC ID: 0446323364 Enrollment ID: I20110823000176 |
| Provider Name | Victoria B Ayden |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1134302086 PECOS PAC ID: 7214108281 Enrollment ID: I20110922000794 |
| Provider Name | Jaime P Hook |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1811198229 PECOS PAC ID: 1153596689 Enrollment ID: I20111213000160 |
| Provider Name | Christina G Simon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1427217116 PECOS PAC ID: 7618044231 Enrollment ID: I20120124000896 |
| Provider Name | Marcie E Garland |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1558517029 PECOS PAC ID: 1759539026 Enrollment ID: I20120911000299 |
| Provider Name | Natasha M Marrus |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1467643528 PECOS PAC ID: 8729237250 Enrollment ID: I20120927000250 |
| Provider Name | Michael S Bunis |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1639300577 PECOS PAC ID: 1951552298 Enrollment ID: I20121113000609 |
| Provider Name | Celeste E Herleth |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1780812743 PECOS PAC ID: 3173766789 Enrollment ID: I20130829000867 |
| Provider Name | Rushaniya A Khairova |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013243476 PECOS PAC ID: 0648404103 Enrollment ID: I20131016001142 |
| Provider Name | Brendan J Oconnor |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1114231925 PECOS PAC ID: 4183853757 Enrollment ID: I20140528001778 |
| Provider Name | Chad M Sylvester |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1538399498 PECOS PAC ID: 8527283381 Enrollment ID: I20140710002080 |
| Provider Name | Caitlin N Gaskell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831505585 PECOS PAC ID: 1254559982 Enrollment ID: I20140821001929 |
| Provider Name | Barbara Reed |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083864268 PECOS PAC ID: 1759503279 Enrollment ID: I20141117000491 |
| Provider Name | Paul E Glaser |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1316020738 PECOS PAC ID: 9133207186 Enrollment ID: I20150505002707 |
| Provider Name | Rebecca Light Pearlman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912047515 PECOS PAC ID: 7416276845 Enrollment ID: I20150506000225 |
| Provider Name | Angela M Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366830978 PECOS PAC ID: 5991022568 Enrollment ID: I20150721000186 |
| Provider Name | Justin E Hampton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184001380 PECOS PAC ID: 9931419942 Enrollment ID: I20151103002336 |
| Provider Name | Dawn L Garzon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265643282 PECOS PAC ID: 3173827300 Enrollment ID: I20160519000120 |
| Provider Name | Eric N Wittrock |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619265865 PECOS PAC ID: 2264660174 Enrollment ID: I20160607001317 |
| Provider Name | Naazia Azhar |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1154686681 PECOS PAC ID: 0840429429 Enrollment ID: I20160919000909 |
| Provider Name | Joshua Lynn Wilson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1609130061 PECOS PAC ID: 7315176039 Enrollment ID: I20161017000779 |
| Provider Name | Jody Np Sims |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184173585 PECOS PAC ID: 2860770211 Enrollment ID: I20161107000132 |
| Provider Name | Jacinda L Berger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699206615 PECOS PAC ID: 6901182534 Enrollment ID: I20170417000661 |
| Provider Name | Ludwig Trillo Alvarez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1336589480 PECOS PAC ID: 1951539980 Enrollment ID: I20170620002077 |
| Provider Name | Erin Nicole Deguzman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689006660 PECOS PAC ID: 9133354822 Enrollment ID: I20170712002464 |
| Provider Name | Emily H Mukherji |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1689995847 PECOS PAC ID: 5597923557 Enrollment ID: I20170926002846 |
| Provider Name | Cynthia L Woodcock |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295735876 PECOS PAC ID: 7618234527 Enrollment ID: I20171201000838 |
| Provider Name | Denise L Wilson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134634470 PECOS PAC ID: 5496015927 Enrollment ID: I20180201001225 |
| Provider Name | Carrie Morris Mintz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1659711042 PECOS PAC ID: 6305075045 Enrollment ID: I20180201001905 |
| Provider Name | Andrea M Giedinghagen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1639519028 PECOS PAC ID: 8628207701 Enrollment ID: I20180626001734 |
| Provider Name | Cassidy Chapman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871097642 PECOS PAC ID: 9335495936 Enrollment ID: I20180712001583 |
| Provider Name | Jessica A Gold |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1033538442 PECOS PAC ID: 3577810696 Enrollment ID: I20180720001191 |
| Provider Name | Elizabeth O'brien |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992243265 PECOS PAC ID: 3971876889 Enrollment ID: I20180802002274 |
| Provider Name | Alecia Cristen Vogel-hammen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1275973745 PECOS PAC ID: 8325276355 Enrollment ID: I20181207001589 |
| Provider Name | Jennifer L Holzhauer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104032168 PECOS PAC ID: 7113267709 Enrollment ID: I20190318002588 |
| Provider Name | Marie A Bosch |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1104209972 PECOS PAC ID: 4385958578 Enrollment ID: I20190624003208 |
| Provider Name | Lauren A Marks |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1790169126 PECOS PAC ID: 0446564355 Enrollment ID: I20190624003277 |
| Provider Name | Kathleen R Mueller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073089322 PECOS PAC ID: 8325373475 Enrollment ID: I20190711000527 |
| Provider Name | Angela Mortensen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982165510 PECOS PAC ID: 6204161359 Enrollment ID: I20190711000616 |
| Provider Name | Rita Haddad |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1780069112 PECOS PAC ID: 8729315023 Enrollment ID: I20190808003913 |
| Provider Name | Emily D Anderson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649744079 PECOS PAC ID: 0244567303 Enrollment ID: I20190812003477 |
| Provider Name | Stephanie G Williams |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487032843 PECOS PAC ID: 6608103403 Enrollment ID: I20190815002218 |
| Provider Name | Michael L Wenzinger |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1386051142 PECOS PAC ID: 0042430407 Enrollment ID: I20190829000597 |
| Provider Name | Christopher Charlot |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1770998650 PECOS PAC ID: 5597985903 Enrollment ID: I20190903000508 |
| Provider Name | Virginia Lanzotti |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386284990 PECOS PAC ID: 0648607812 Enrollment ID: I20200227002227 |
| Provider Name | Erin Morrison |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1417334442 PECOS PAC ID: 1658673363 Enrollment ID: I20200622000849 |
| Provider Name | Bridget Mary Galati |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1083065197 PECOS PAC ID: 5496177370 Enrollment ID: I20200623001193 |
| Provider Name | Katie E Wilson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1225185119 PECOS PAC ID: 6709939226 Enrollment ID: I20200831002403 |
| Provider Name | Max S Rosen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255715793 PECOS PAC ID: 3779897954 Enrollment ID: I20200910003362 |
| Provider Name | Alexandria Grodie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063021905 PECOS PAC ID: 3274952353 Enrollment ID: I20200924000166 |
| Provider Name | Allison Rebecca Optican |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1629429865 PECOS PAC ID: 4688908551 Enrollment ID: I20200930002416 |
| Provider Name | Desiree C Baumgartner |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1811370273 PECOS PAC ID: 8729392709 Enrollment ID: I20201230000890 |
| Provider Name | Amelia M Sotnyk |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194301325 PECOS PAC ID: 5799193934 Enrollment ID: I20210428000419 |
| Provider Name | David N Daniels |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1639512809 PECOS PAC ID: 2365744745 Enrollment ID: I20210428000552 |
| Provider Name | Baris C Ercal |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1992225957 PECOS PAC ID: 6305170275 Enrollment ID: I20210616003504 |
| Provider Name | Victoria De Leon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1083135818 PECOS PAC ID: 3971903626 Enrollment ID: I20210616003697 |
| Provider Name | Jarrod A Holiday |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1033560131 PECOS PAC ID: 2668802976 Enrollment ID: I20210617003166 |
| Provider Name | Natchanan Charatcharungkiat |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1922450956 PECOS PAC ID: 1153654827 Enrollment ID: I20210625001072 |
| Provider Name | John Bilbily |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1912427568 PECOS PAC ID: 7315349578 Enrollment ID: I20210709001770 |
| Provider Name | Celina R Jacobi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1699126706 PECOS PAC ID: 6709119092 Enrollment ID: I20210722000221 |
| Provider Name | Michael R Leveque |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1841531548 PECOS PAC ID: 1658775333 Enrollment ID: I20210803000291 |
| Provider Name | Timothy O Laumann |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1811418122 PECOS PAC ID: 5395079263 Enrollment ID: I20210920000313 |
| Provider Name | Matthew Zide |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922752591 PECOS PAC ID: 6901292259 Enrollment ID: I20220413001537 |
| Provider Name | Kevin Y Xu |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1639664774 PECOS PAC ID: 3577897453 Enrollment ID: I20220519001124 |
| Provider Name | Stephanie Lynn Clark |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1598156622 PECOS PAC ID: 5193103430 Enrollment ID: I20220527001493 |
| Provider Name | Matthew B Chapman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1821583949 PECOS PAC ID: 9133453749 Enrollment ID: I20220601001143 |
| Provider Name | Gregory Cejas |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1225558802 PECOS PAC ID: 8426382037 Enrollment ID: I20220608001249 |
| Provider Name | Christopher Robert Berghoff |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1871235028 PECOS PAC ID: 7214316959 Enrollment ID: I20220627000872 |
| Provider Name | Angela H Lin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1649765793 PECOS PAC ID: 0143554022 Enrollment ID: I20220628003506 |
| Provider Name | Joshua Sarfaty Siegel |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1942795083 PECOS PAC ID: 5597148098 Enrollment ID: I20220816003108 |
| Provider Name | Tara Nichole Tinnin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447977509 PECOS PAC ID: 4183091101 Enrollment ID: I20221104000532 |
| Provider Name | Kathryn Lavinia Galvin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649994476 PECOS PAC ID: 0143697177 Enrollment ID: I20221104000664 |
| Provider Name | Joshua Lawrence Jones |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699237826 PECOS PAC ID: 6204203094 Enrollment ID: I20221108001821 |
| Provider Name | Joanna Rosenthal |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932484177 PECOS PAC ID: 1153583646 Enrollment ID: I20221128000614 |
| Provider Name | Savannah Leigh Helton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942963228 PECOS PAC ID: 4183092943 Enrollment ID: I20221129000810 |
| Provider Name | Ebonee M Lyle |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699025866 PECOS PAC ID: 4587034111 Enrollment ID: I20221222002707 |
| Provider Name | Kirsten Elizabeth Gilbert |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1770803512 PECOS PAC ID: 7719357292 Enrollment ID: I20221227000722 |
| Provider Name | Bianca Z Mehegan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912371204 PECOS PAC ID: 0941598510 Enrollment ID: I20230106001633 |
| Provider Name | Mackenzie L Hynes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447945472 PECOS PAC ID: 8426414301 Enrollment ID: I20230518002591 |
| Provider Name | Susan M Banashek |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821002106 PECOS PAC ID: 9537526272 Enrollment ID: I20230612000677 |
| Provider Name | Christine Juang |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1871135400 PECOS PAC ID: 1355775842 Enrollment ID: I20230612001254 |
| Provider Name | Darin Chia Fay Quach |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1679068761 PECOS PAC ID: 9931566692 Enrollment ID: I20230612001380 |
| Provider Name | Anatoliy Kuznetsov |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1265937080 PECOS PAC ID: 9234524703 Enrollment ID: I20230612001643 |
| Provider Name | Christina Lucido Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962115618 PECOS PAC ID: 8325407968 Enrollment ID: I20230629003509 |
| Provider Name | Reuben Robinson Welch |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1235484841 PECOS PAC ID: 8729449459 Enrollment ID: I20230727003782 |
| Provider Name | Anna M Constantino-pettit |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174971345 PECOS PAC ID: 5991166597 Enrollment ID: I20230728003169 |
| Provider Name | Tatiyahna L Richardson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962110023 PECOS PAC ID: 0143681775 Enrollment ID: I20230731000586 |
| Provider Name | Brittany Kay Rose |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639853948 PECOS PAC ID: 5799147641 Enrollment ID: I20230809004077 |
| Provider Name | Shannon R Mcguire |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1134780471 PECOS PAC ID: 3274869284 Enrollment ID: I20230906001390 |
| Provider Name | Licia Brianna Dones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871290882 PECOS PAC ID: 9931559150 Enrollment ID: I20231229000547 |
| Provider Name | Jessica E Rodriguez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528840733 PECOS PAC ID: 4486005790 Enrollment ID: I20240111001875 |
| Provider Name | Sara E Collins |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1760788228 PECOS PAC ID: 2365820347 Enrollment ID: I20240123003234 |
| Provider Name | Amaly Yossef |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649972134 PECOS PAC ID: 5294178950 Enrollment ID: I20240209000294 |
| Provider Name | Nathan A Oatis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295505667 PECOS PAC ID: 3870937048 Enrollment ID: I20240215001128 |
| Provider Name | Rebeca M Hilleman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073873550 PECOS PAC ID: 3274977970 Enrollment ID: I20240221003085 |
| Provider Name | Katherine Aravamudan |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1720412893 PECOS PAC ID: 3072958222 Enrollment ID: I20240228001105 |
| Provider Name | Alicia L Ott |
|---|---|
| Provider Type | Practitioner - Other (non-physician) |
| Provider Identifiers | NPI Number: 1811492598 PECOS PAC ID: 4183069925 Enrollment ID: I20240301003388 |
| Provider Name | Mary Grace Portell |
|---|---|
| Provider Type | Practitioner - Other (non-physician) |
| Provider Identifiers | NPI Number: 1013286996 PECOS PAC ID: 0648615393 Enrollment ID: I20240304002515 |
| Provider Name | Shae Lynn Strom |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477183689 PECOS PAC ID: 4082050570 Enrollment ID: I20240306003421 |
| Provider Name | Jennifer D Pautsch |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1467023259 PECOS PAC ID: 8921444274 Enrollment ID: I20240309000494 |
| Provider Name | Maura Elizabeth Caldwell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1730835711 PECOS PAC ID: 4688010721 Enrollment ID: I20240311003436 |
| Provider Name | Krista Nichole Jarvis |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1134358062 PECOS PAC ID: 4385080498 Enrollment ID: I20240312001721 |
| Provider Name | Amanda Briggs Baker |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1750017513 PECOS PAC ID: 6204297716 Enrollment ID: I20240313001793 |
St. Louis Center For Preventive And Longevity Medicine, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 777 S New Ballas Rd, Suite 200 E, Saint Louis, MO 63141 Phone: 314-994-1536 Fax: 314-692-0241 | |
Town And Country Primary Care Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3009 N Ballas Rd, Suite 300a, Saint Louis, MO 63131 Phone: 314-872-8999 | |
Family Care Health Centers Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1001 Lynch St, Saint Louis, MO 63118 Phone: 314-531-5444 Fax: 314-531-0063 | |
Wusm Bjc Aco Providers Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 660 S Euclid Ave, Campus Box 8081, Saint Louis, MO 63110 Phone: 314-273-0770 | |
Victus Physician Services, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 12607 Olive Blvd, Saint Louis, MO 63141 Phone: 314-327-8070 | |
Salvation Army Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2900 Washington Ave, Saint Louis, MO 63103 Phone: 314-898-1700 Fax: 314-814-8542 | |
Dtg Ii Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3819 Tesson Ct, Saint Louis, MO 63123 Phone: 800-268-7713 Fax: 415-704-3294 |