NPIMap

Organization Active NPI

Mercy Clinic Kids Gi, LLC

  • Pediatric Gastroenterology Physician
  • Saint Louis, MO
National Provider Identifier
1033352885
Registry record updated Apr 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
Legal business name
MERCY CLINIC KIDS GI, LLC
Practice address
621 S New Ballas Rd
Suite 140-a
Saint Louis, MO 63141-8232
Phone
(314) 996-0006
Fax
(314) 996-0007
NPI assigned
Apr 9, 2009
Last updated
Apr 25, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
MERCY CLINIC EAST COMMUNITIESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 25, 2025

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

Authorized official

Name
Kerry Dunger
Title
Executive Director - Finance
Phone
(314) 364-3707

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Gastroenterology Physician 2080P0206X NU Primary

Addresses

Primary practice location

621 S New Ballas Rd
Suite 140-a
Saint Louis, MO 63141-8232

Mailing address

621 S New Ballas Rd Ste Y-G230
Saint Louis, MO 63141-8232
Phone (314) 251-5550

Other practice location 1

211 Saint Francis Dr
Cape Girardeau, MO 63703-5049
Phone (314) 251-5550

Other practice location 2

4525 Mid Rivers Mall Dr Ste 10
Cottleville, MO 63376-2820
Phone (314) 251-5550

Other identifiers 1

IdentifierTypeStateIssuer
509292504MedicaidMO

Other names 1

  • St. John's Mercy Kids GI, LLC Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160523002667 MO Part B Supplier - Clinic/Group Practice 3476842956 Receives reassigned benefits from 9 practitioners
Practice locations: Cottleville, MO; Saint Louis, MO

National Provider Directory

National Provider Directory
Part of
Mercy Clinic Communities

Locations

621 S New Ballas Rd
Ste 140A
Saint Louis, MO 63141
Phone (314) 251-5300

621 S New Ballas Rd
Ste YG230
Saint Louis, MO 63141

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1239235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745539200000",
    "number": "1033352885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 S NEW BALLAS RD STE Y-G230",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418232",
            "telephone_number": "314-251-5550",
            "fax_number": "314-251-5552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 S NEW BALLAS RD",
            "address_2": "SUITE 140-A",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418232",
            "telephone_number": "314-996-0006",
            "fax_number": "314-996-0007"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "211 Saint Francis Dr",
            "address_purpose": "LOCATION",
            "city": "Cape Girardeau",
            "state": "MO",
            "postal_code": "637035049",
            "country_code": "US",
            "telephone_number": "314-251-5550",
            "fax_number": "314-251-5552",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4525 Mid Rivers Mall Dr Ste 10",
            "address_purpose": "LOCATION",
            "city": "Cottleville",
            "state": "MO",
            "postal_code": "633762820",
            "country_code": "US",
            "telephone_number": "314-251-5550",
            "fax_number": "314-521-5552",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MERCY CLINIC KIDS GI, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MERCY CLINIC EAST COMMUNITIES",
        "enumeration_date": "2009-04-09",
        "last_updated": "2025-04-25",
        "certification_date": "2025-04-25",
        "status": "A",
        "authorized_official_last_name": "DUNGER",
        "authorized_official_first_name": "KERRY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR - FINANCE",
        "authorized_official_telephone_number": "314-364-3707"
    },
    "taxonomies": [
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "509292504",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. John's Mercy Kids GI, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "St. John's Mercy Kids GI, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.