Michele L Niemczyk, DO

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

2005017812 Issued in MO

Practice address

11642 W Florissant Ave
Florissant, MO 63033-6723

Phone

(314) 838-8220

Fax

(314) 830-1873

NPI assigned

Jul 11, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Interoperability endpoints

• Direct secure messaging: michele.niemczyk.p1@direct.phcenters.nextgenshare.com

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.

• Betty Jean Kerr People's Health Centers

  • Federally Qualified Health Center (FQHC)
  • Saint Louis, MO
  • NPI 1194797787
  NPD (past)

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728000000000",
    "number": "1083649024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5701 DELMAR BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631122617",
            "telephone_number": "314-367-7848",
            "fax_number": "314-367-2985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11642 W FLORISSANT AVE",
            "city": "FLORISSANT",
            "state": "MO",
            "postal_code": "630336723",
            "telephone_number": "314-838-8220",
            "fax_number": "314-830-1873"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5701 Delmar Blvd",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631122617",
            "country_code": "US",
            "telephone_number": "314-367-7848",
            "fax_number": "314-367-8796",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NIEMCZYK",
        "first_name": "MICHELE",
        "middle_name": "L",
        "name_prefix": "Miss",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-11",
        "last_updated": "2024-10-04",
        "certification_date": "2024-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2005017812",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "2005017812",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "207489808",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Thoai Anh Bao Nguyen
• Charles Douglas Nickels, R. PH.
• Meredith Niedringhaus
• John Nieland
• Trulie Nacole Nielsen, OTR/L
• Nightingale Home Care, LLC
• Nightingale Home Services
• Nirvana Healthcare LLC
• Ariana Nobles
• Brittney Nolin

• Pediatrics Physician in Florissant, MO
• Providers in Florissant, MO by specialty
• Pediatrics Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.