Individual provider Active NPI

Kellie M Odonnell-Stockton, N.P.

  • Nurse Practitioner
  • Saint Charles, MO
National Provider Identifier
1033314976
Registry record updated Oct 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
2000172033 Issued in MO
Practice address
711 Veterans Memorial Pkwy Ste 300
Saint Charles, MO 63303-2106
Phone
(636) 669-2350
NPI assigned
Jun 20, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 2000172033 MO
Nurse Practitioner 363L00000X 2000172033 MO Primary

Addresses

Primary practice location

711 Veterans Memorial Pkwy Ste 300
Saint Charles, MO 63303-2106

Mailing address

PO Box 955534
Saint Louis, MO 63195-5534

Other practice location 1

201 Bjc Saint Peters Dr
suite 100
Saint Peters, MO 63376-3091
Phone (636) 916-8200

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address kodonnellstockton518933@direct-ehr-ssmhc.com Direct
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other

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
I20240830000235 MO Practitioner - Nurse Practitioner 4981143252 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SSM Medical Group IncGroup PAC ID 6608776299, 565 clinicians

Practice addresses (Care Compare)

711 Veterans Memorial Pkwy
Suite 300
Saint Charles, MO 63303-2106
Phone (636) 669-2350

Hospital & facility affiliations

  • SSM St Joseph Health Center Hospital, Saint Charles, MO, CCN 260005
  • SSM St Joseph Hospital West Hospital, Lake Saint Louis, MO, CCN 260200
  • SSM Health Rehabilitation Hospital Inpatient rehabilitation facility, Richmond Heights, MO, CCN 263031

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2000172033MOMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
SSM Medical Group Inc. CurrentSince Sep 1, 2024 Accepting new patients
SSM Medical Group, Inc. CurrentSince Sep 1, 2024 Accepting new patients
SSM Health Care St. Louis Past Accepting new patients

Locations

711 Veterans Memorial Pkwy
Ste 300
Saint Charles, MO 63303
Phone (636) 669-2215

3555 Sunset Office Dr
Ste C100
Saint Louis, MO 63127
Phone (314) 238-9100

1035 Bellevue Ave
Ste 500
Saint Louis, MO 63117
Phone (314) 647-1115

Interoperability endpoints

  • Direct secure messaging: kodonnellstockton518933@direct-ehr-ssmhc.com

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.

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": "1182297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728604800000",
    "number": "1033314976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 955534",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631955534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 VETERANS MEMORIAL PKWY STE 300",
            "city": "SAINT CHARLES",
            "state": "MO",
            "postal_code": "633032106",
            "telephone_number": "636-669-2350"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "201 Bjc Saint Peters Dr",
            "address_2": "suite 100",
            "address_purpose": "LOCATION",
            "city": "Saint Peters",
            "state": "MO",
            "postal_code": "633763091",
            "country_code": "US",
            "telephone_number": "636-916-8200",
            "fax_number": "636-916-8239",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ODONNELL-STOCKTON",
        "first_name": "KELLIE",
        "middle_name": "M",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-20",
        "last_updated": "2024-10-11",
        "certification_date": "2024-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2000172033",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MO",
            "license": "2000172033",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kodonnellstockton518933@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "kodonnellstockton518933@direct-ehr-ssmhc.com",
            "address_1": "711 Veterans Memorial Pkwy Ste 300",
            "city": "Saint Charles",
            "state": "MO",
            "country_code": "US",
            "postal_code": "633032106",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "711 Veterans Memorial Pkwy Ste 300",
            "city": "Saint Charles",
            "state": "MO",
            "country_code": "US",
            "postal_code": "633032106",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Charles, MO

Sources for this page

Verify at the official NPI Registry.