NPIMap

Organization Active NPI

Mercy Clinic Dermatology LLC

  • Dermatology Physician
  • Washington, MO
National Provider Identifier
1033470745
Registry record updated Feb 19, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
MERCY CLINIC DERMATOLOGY LLC
Practice address
901 Patients First Dr Ste 3600
Washington, MO 63090-4700
Phone
(636) 390-1595
Fax
(636) 390-1596
NPI assigned
May 30, 2012
Organization subpart
Yes
Parent organization
MERCY CLINIC EAST COMMUNITIESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 19, 2026

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

Authorized official

Name
Jonathan Tyler Sturgeon
Title
Cfo
Phone
(314) 251-1917

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X MO Primary

Addresses

Primary practice location

901 Patients First Dr Ste 3600
Washington, MO 63090-4700

Mailing address

901 Patients First Dr Ste 3600
Washington, MO 63090-4700
Phone (636) 390-1595

Other identifiers 2

IdentifierTypeStateIssuer
DT7966OtherMORAILROAD MEDICARE
1033470745MedicaidMO

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121017000625 MO Part B Supplier - Clinic/Group Practice 2769632322 Receives reassigned benefits from 3 practitioners
Practice locations: Washington, MO

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D2078290Mercy Dermatology901 Patients First Drive, Washington, MO 63090Provider-performed microscopyMay 26, 2028

National Provider Directory

National Provider Directory
Part of
St John'S Mercy Medical Group

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

637 Dunn Rd
Ste 102B
Hazelwood, MO 63042
Phone (314) 251-2095

621 S New Ballas Rd
Ste 597
Saint Louis, MO 63141

605 E Booneslick Rd
Ste B
Warrenton, MO 63383
Phone (636) 456-3413

901 Patients First Dr
Ste 3600
Washington, MO 63090
Phone (636) 390-1595

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 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1338336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1771459200000",
    "number": "1033470745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 PATIENTS FIRST DR STE 3600",
            "city": "WASHINGTON",
            "state": "MO",
            "postal_code": "630904700",
            "telephone_number": "636-390-1595",
            "fax_number": "636-390-1596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 PATIENTS FIRST DR STE 3600",
            "city": "WASHINGTON",
            "state": "MO",
            "postal_code": "630904700",
            "telephone_number": "636-390-1595",
            "fax_number": "636-390-1596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY CLINIC DERMATOLOGY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MERCY CLINIC EAST COMMUNITIES",
        "enumeration_date": "2012-05-30",
        "last_updated": "2026-02-19",
        "certification_date": "2026-02-19",
        "status": "A",
        "authorized_official_last_name": "STURGEON",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "TYLER",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "314-251-1917"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "MO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DT7966",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1033470745",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.