Howard Jay Ilivicky, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

MD61660624 Issued in WA

Practice address

330 1St Capitol Dr
Ste 390
Saint Charles, MO 63301-2852

Phone

(636) 949-5760

Fax

(636) 949-0729

NPI assigned

Jun 23, 2005

Last updated

Apr 8, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WA

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

Specialty

Psychiatry

Education

Washington University School of Medicine, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Mindful Health Solutions Wa PCGroup PAC ID 7911382072, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: howard.ilivicky.1@18773.direct.athenahealth.com
• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Mindful Health Solutions Wa PC

  dba Mindful Health Solutions

  • Psychiatry Physician
  • Seattle, WA
  • NPI 1417692740
  Medicare reassignment Care Compare group NPD
• Garry Vickar & Associates

  • Psychiatry Physician
  • Saint Louis, MO
  • NPI 1780716696
  NPD (past)
• St. Charles Psychiatric Associates, Inc.

  • Specialist
  • Weldon Spring, MO
  • NPI 1164631495
  NPD (past)

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

{
    "created_epoch": "1119484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744070400000",
    "number": "1093711152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4132 KEATON CROSSING BLVD",
            "address_2": "STE 201",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633688222",
            "telephone_number": "636-244-3589",
            "fax_number": "636-244-3594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 1ST CAPITOL DR",
            "address_2": "STE 390",
            "city": "SAINT CHARLES",
            "state": "MO",
            "postal_code": "633012852",
            "telephone_number": "636-949-5760",
            "fax_number": "636-949-0729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ILIVICKY",
        "first_name": "HOWARD",
        "middle_name": "JAY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-23",
        "last_updated": "2025-04-08",
        "certification_date": "2025-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MO",
            "license": "118786",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WA",
            "license": "MD61660624",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "415921",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "122112",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James Kyusik Hwang, D.M.D.
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• Ayobami Rasak Ibitoye
• Chika Ijioma
• Independent Nurse Company, LLC (Independent Nurse Co.)
• Brittney Nicole Ingram, MS PLPC
• Emma Ingram
• Kacie Nicole Ingrassia, LPC
• Tony Ingrassia, MAC, CIT

• Psychiatry Physician in Saint Charles, MO
• Providers in Saint Charles, MO by specialty
• Psychiatry Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2025; 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.