Individual provider Active NPI

Andrea N Reich, PNP

  • Pediatric Nurse Practitioner
  • Saint Louis, MO
National Provider Identifier
1104192772
Registry record updated Apr 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
2012005442 Issued in MO
Practice address
6526 Lansdowne Ave
Saint Louis, MO 63109-2654
Phone
(314) 353-8777
Fax
(314) 353-8772
NPI assigned
Mar 28, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 2012005442 MO Primary

Addresses

Primary practice location

6526 Lansdowne Ave
Saint Louis, MO 63109-2654

Mailing address

PO Box 7412045
Chicago, IL 60674-2045
Phone (314) 353-8777

Other identifiers 1

IdentifierTypeStateIssuer
420057535MedicaidMO

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Washington University

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180627003289 MO Practitioner - Nurse Practitioner 5799031142 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
2012005442MOMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Wuca Southwest Pediatrics LLC CurrentSince Jul 1, 2018 Accepting new patients
Washington University Past Accepting new patients

Locations

6526 Lansdowne Ave
Saint Louis, MO 63109
Phone (314) 353-8777

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1332892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744934400000",
    "number": "1104192772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7412045",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606742045",
            "telephone_number": "314-353-8777",
            "fax_number": "314-353-8772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6526 LANSDOWNE AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631092654",
            "telephone_number": "314-353-8777",
            "fax_number": "314-353-8772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REICH",
        "first_name": "ANDREA",
        "middle_name": "N",
        "name_prefix": "Ms.",
        "credential": "PNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-28",
        "last_updated": "2025-04-18",
        "certification_date": "2025-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MO",
            "license": "2012005442",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "420057535",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "6526 Lansdowne Ave",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631092654",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.