Maryjo Hernandez-Zipfel, MD
Individual provider Active NPI Pediatric Adolescent Medicine Physician · Saint Louis, MO
NPI 1023036746 · NPPES record last updated May 15, 2019
Key facts
- NPI
- 1023036746
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Adolescent Medicine Physician 2080A0000X
- License
- 2004009985 (MO)
- Practice address
- 4055 Lindell Blvd
Saint Louis, MO 63108-3201 - Phone
- (314) 535-7701
- NPI assigned
- Jul 18, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20041101000259 | MO | Practitioner - Pediatric Medicine | 9638131873 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2004009985 | MO | MD | Neonatal-Perinatal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercy Hospitals East Communities | Current |
Accepting new patients | |
| Mercy Hospitals East Communities | Current |
Accepting new patients |
Locations
615 S New Ballas Rd
Saint Louis, MO 63141
Phone (314) 251-4687
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neonatal-Perinatal Medicine Physician | 2080N0001X | 2004009985 | MO | |
| Pediatric Emergency Medicine (Pediatrics) Physician | 2080P0204X | 2004009985 | MO | |
| Pediatric Adolescent Medicine Physician | 2080A0000X | 2004009985 | MO | Yes |
Addresses
Primary practice location
4055 Lindell Blvd
Saint Louis, MO 63108-3201
Mailing address
4055 Lindell Blvd
Saint Louis, MO 63108-3201
Phone (314) 535-7701
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 190299 | Other | MO-BLUE SHIELD | |
| 206177305 | Medicaid | MO |
Other providers in Saint Louis, MO
- Jessica Hermann
- Daniela Hermelin
- Ruben Alfonso Hernandez Acosta
- Maday Hernandez-Fernandez
- Milarys Hernandez-Martinez
- Alexander Erasto Hernandez
- Aylin Hernandez
- Dagmara Hernandez
- Deborah Hernandez
- Guillermo Eloy Hernandez
All providers in Saint Louis, MO · Pediatric Adolescent Medicine Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 15, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.