Individual provider Active NPI

Alexandra Mayberry

  • Family Nurse Practitioner
  • Saint Louis, MO
National Provider Identifier
1023779378
Registry record updated Jan 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
2021018971 Issued in MO
Practice address
3655 Vista Ave
Saint Louis, MO 63110-2539
Phone
(314) 577-6056
NPI assigned
Jan 7, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 2021018971 MO Primary

Addresses

Primary practice location

3655 Vista Ave
Saint Louis, MO 63110-2539

Mailing address

233 N 1St St
Breese, IL 62230-1617

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
I20220215002048 MO Practitioner - Nurse Practitioner 5496148454 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SSM Health Care GroupGroup PAC ID 0143608372, 929 clinicians

Practice addresses (Care Compare)

10101 Woodfield LN
Saint Louis, MO 63132-2946
Phone (608) 280-4647

3635 Vista Ave
Saint Louis, MO 63110-2539
Phone (314) 257-7400

3655 Vista Ave
Saint Louis, MO 63110-2539
Phone (314) 977-4663

3685 Vista Ave
Saint Louis, MO 63110-2539
Phone (314) 257-7000

Hospital & facility affiliations

  • SSM Health Saint Louis University Hospital Hospital, Saint Louis, MO, CCN 260105
  • SSM Health St Mary'S Hospital - St Louis Hospital, Saint Louis, MO, CCN 260091

Merit-based Incentive Payment System (MIPS)

Final score
84.94 of 100Reported as group
Quality
68.52
Promoting interoperability
100
Improvement activities
40
Cost
72.22

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2021018971MOMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
SSM Health Care Group CurrentSince Jul 1, 2022 Accepting new patients
SSM Health Care Group CurrentSince Jul 1, 2022 Accepting new patients
Ozarks Medical Center Past Accepting new patients
SSM Medical Group Inc. Past Accepting new patients

Locations

10101 Woodfield Ln
Saint Louis, MO 63132
Phone (608) 280-4647

3655 Vista Ave
Saint Louis, MO 63110
Phone (314) 977-5110

3635 Vista Ave
Saint Louis, MO 63110
Phone (314) 577-8022

Interoperability endpoints

  • Direct secure messaging: amayberry416366@direct-ehr-ssmhc.com

Organizations & group practices 4

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1641513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641513600000",
    "number": "1023779378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "233 N 1ST ST",
            "city": "BREESE",
            "state": "IL",
            "postal_code": "622301617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3655 VISTA AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631102539",
            "telephone_number": "314-577-6056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAYBERRY",
        "first_name": "ALEXANDRA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-07",
        "last_updated": "2022-01-07",
        "certification_date": "2022-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2021018971",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.