Heather Popham, NP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

2011041207 Issued in MO

Practice address

3009 N Ballas Rd
Ste 207B
Saint Louis, MO 63131-2322

Phone

(314) 996-7960

Fax

(314) 989-0235

NPI assigned

Jan 24, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Nurse Practitioner

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Impact Physician Group Missouri LLCGroup PAC ID 4082958574, 18 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• Impact Physician Group, Missouri, LLC

  • Internal Medicine Physician
  • Bridgeton, MO
  • NPI 1962971531
  Medicare reassignment Care Compare group NPD
• Serenity Health LLC

  • Psychiatry Physician
  • Saint Peters, MO
  • NPI 1104569151
  Medicare reassignment NPD
• Physician Groups LC

  • Multi-Specialty Clinic/Center
  • Saint Louis, MO
  • NPI 1285664268
  NPD (past)
• St. Louis Internal Medicine Inc

  • Internal Medicine Physician
  • Saint Louis, MO
  • NPI 1104856442
  NPD (past)

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

{
    "created_epoch": "1327363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413331200000",
    "number": "1093086985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "670 MASON RIDGE CENTER DR",
            "address_2": "STE 300",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418573",
            "telephone_number": "314-996-7960",
            "fax_number": "314-989-0235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3009 N BALLAS RD",
            "address_2": "STE 207B",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631312322",
            "telephone_number": "314-996-7960",
            "fax_number": "314-989-0235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POPHAM",
        "first_name": "HEATHER",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-01-24",
        "last_updated": "2014-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MO",
            "license": "2011041207",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nongnooch Poowanawittayakom, MD
• Abbi Lyn Pope ( Piper)
• Myesha Pope, MSW
• Spencer Ryan Pope, DO
• Brooke L Popejoy, SRNA
• Arthur Popkowski, DDS
• Simisolaoluwa Ademide Popoola, MD
• Emily S Popovic, DO
• Dennis A. Popp, M.D.
• Cristian Popu, MD

• Adult Health Nurse Practitioner in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Adult Health Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2014; 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.
• 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.