Individual provider Active NPI

Kathleen A Bernhard, M.D.

  • Pediatrics Physician
  • Washington, MO
National Provider Identifier
1073590550
Registry record updated May 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
R1P69 Issued in MO
Practice address
851 E 5TH St
Washington, MO 63090-3135
Phone
(636) 239-8338
Fax
(636) 239-8553
NPI assigned
Dec 27, 2005
Last updated
May 4, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 4, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X R1P69 MO Primary

Addresses

Primary practice location

851 E 5TH St
Washington, MO 63090-3135

Mailing address

851 E 5TH St
Washington, MO 63090-3135
Phone (636) 239-8338

Other identifiers 1

IdentifierTypeStateIssuer
203169404MedicaidMO

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050308000822 MO Practitioner - Pediatric Medicine 1850345364 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
R1P69MOMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
County of St Louis Division of Fiscal Management CurrentSince Jul 2, 2018 Accepting new patients
County of St Louis Division of Fiscal Management CurrentSince Jul 2, 2018 Accepting new patients
Mercy Clinic East Communities Pediatrics Past Accepting new patients

Locations

6121 N Hanley Rd
Saint Louis, MO 63134
Phone (314) 522-6410

6121 N Hanley Rd
#C
Saint Louis, MO 63134
Phone (314) 615-0500

Interoperability endpoints

  • Direct secure messaging: kbernhard197592@directc.mercy.net

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1135641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1304467200000",
    "number": "1073590550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "851 E 5TH ST",
            "city": "WASHINGTON",
            "state": "MO",
            "postal_code": "630903135",
            "telephone_number": "636-239-8338",
            "fax_number": "636-239-8553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "851 E 5TH ST",
            "city": "WASHINGTON",
            "state": "MO",
            "postal_code": "630903135",
            "telephone_number": "636-239-8338",
            "fax_number": "636-239-8553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERNHARD",
        "first_name": "KATHLEEN",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-27",
        "last_updated": "2011-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "R1P69",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "203169404",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, MO

Sources for this page

Verify at the official NPI Registry.