Individual provider Active NPI

Elizabeth Burton Walden- Prater, AGNP

  • Nurse Practitioner
  • Saint Louis, MO
National Provider Identifier
1003323288
Registry record updated Apr 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
2018004474 Issued in MO
Practice address
1044 N Mason Rd
Div Im General Med, Ste 330
Saint Louis, MO 63141-6431
Phone
(314) 996-8103
Fax
(314) 996-3230
NPI assigned
Jan 9, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 2018004474 MO Primary

Addresses

Primary practice location

1044 N Mason Rd
Div Im General Med, Ste 330
Saint Louis, MO 63141-6431

Mailing address

PO Box 7412011
Chicago, IL 60674-2011
Phone (314) 996-8103

Other identifiers 1

IdentifierTypeStateIssuer
420051251MedicaidMO

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Washington University

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
I20180411003098 MO Practitioner - Nurse Practitioner 7416210067 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Washington UniversityGroup PAC ID 9830008770, 2,968 clinicians
Physical Therapy Spine and Sports Medicine LLCGroup PAC ID 3173654936, 123 clinicians

Practice addresses (Care Compare)

1044 N Mason Rd
Suite 330
Saint Louis, MO 63141-6689
Phone (314) 362-3500

15425 Manchester Rd
Suite 28
Ballwin, MO 63011-3077
Phone (636) 220-6969

Merit-based Incentive Payment System (MIPS)

Final score
84.2 of 100Reported as group
Quality
71.6
Promoting interoperability
100
Improvement activities
40
Cost
75.75

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2018004474MOMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Washington University Past Accepting new patients

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": "1515456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745193600000",
    "number": "1003323288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7412011",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606742011",
            "telephone_number": "314-996-8103",
            "fax_number": "314-996-3230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1044 N MASON RD",
            "address_2": "DIV IM GENERAL MED, STE 330",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631416431",
            "telephone_number": "314-996-8103",
            "fax_number": "314-996-3230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALDEN- PRATER",
        "first_name": "ELIZABETH",
        "middle_name": "BURTON",
        "name_prefix": "Ms.",
        "credential": "AGNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-09",
        "last_updated": "2025-04-21",
        "certification_date": "2021-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MO",
            "license": "2018004474",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "420051251",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "1044 N Mason Rd",
            "address_2": "Div IM General Med, Ste 330",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631416431",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.