Individual provider Active NPI

Jessica Lyn Burich, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Saint Louis, MO
National Provider Identifier
1003268152
Registry record updated Jan 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
2022043250 Issued in MO
Practice address
1129 Macklind Ave
Saint Louis, MO 63110-1440
Phone
(314) 534-0200
Fax
(314) 534-7996
NPI assigned
Jul 12, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 2022043250 MO Primary

Addresses

Primary practice location

1129 Macklind Ave
Saint Louis, MO 63110-1440

Mailing address

1129 Macklind Ave
Saint Louis, MO 63110-1440
Phone (314) 534-0200

Other names 1

  • Jessica Lyn Thompson Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240703002262 MO Practitioner - Nurse Practitioner 7012451883 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St. Louis Behavioral Medicine Institute IncGroup PAC ID 3173428638, 67 clinicians

Practice addresses (Care Compare)

1129 Macklind Ave
Saint Louis, MO 63110-1440
Phone 3145340200415

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
2022043250MOMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St. Louis Behavioral Medicine Institute Inc CurrentSince Jun 3, 2024 Accepting new patients
St. Louis Behavioral Medicine Institute Inc CurrentSince Jun 3, 2024 Accepting new patients
St. Charles Psychiatric Associates, Inc. PastSince Jun 13, 2024 Accepting new patients

Locations

1129 Macklind Ave
Saint Louis, MO 63110
Phone (314) 534-0200

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1468281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735776000000",
    "number": "1003268152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1129 MACKLIND AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101440",
            "telephone_number": "314-534-0200",
            "fax_number": "314-534-7996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1129 MACKLIND AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101440",
            "telephone_number": "314-534-0200",
            "fax_number": "314-534-7996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURICH",
        "first_name": "JESSICA",
        "middle_name": "LYN",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-12",
        "last_updated": "2025-01-02",
        "certification_date": "2024-12-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MO",
            "license": "2022043250",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "THOMPSON",
            "middle_name": "LYN",
            "credential": "RN, BSN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.