Mary J Bjornstad, FNP
Individual provider Active NPI Family Nurse Practitioner · Sullivan, MO
NPI 1104935261 · NPPES record last updated May 13, 2021
Key facts
- NPI
- 1104935261
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 072682 (MO)
- Practice address
- 965 Mattox Dr
Sullivan, MO 63080-2365 - Phone
- (573) 860-6000
- Fax
- (573) 860-6016
- NPI assigned
- Aug 30, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080220000040 | MO | Practitioner - Nurse Practitioner | 5991889628 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Missouri Baptist Hospital of Sullivan | Current |
Accepting new patients | |
| Missouri Baptist Hospital of Sullivan | Current | Accepting new patients | |
| Physician Groups LC | Past | Accepting new patients |
Locations
102 Ozark Dr
#B
Cuba, MO 65453
Phone (573) 860-6600
670 Mason Ridge Center Dr
Ste 300
Saint Louis, MO 63141
Phone (314) 953-8250
965 Mattox Dr
Sullivan, MO 63080
Phone (573) 468-7054
1780 Old Highway 50 E
Ste 102
Union, MO 63084
Phone (636) 583-1611
Interoperability endpoints
- https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 072682 | MO | Yes |
Addresses
Primary practice location
965 Mattox Dr
Sullivan, MO 63080-2365
Mailing address
965 Mattox Dr
Sullivan, MO 63080-2365
Phone (573) 860-6000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 425813508 | Medicaid | MO |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| FHIR URL | https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ | Health Information Exchange (HIE) |
Other providers in Sullivan, MO
- Aleta Diane Beaty
- Katherine M Beckett
- Bel Oak of Meramec LLC
- Cassidy Victoria Bellville
- Bio-Medical Applications of Missouri, Inc.
- Sadie Blankenship
- Barbara L Blaue
- Catherine Marie Blunda
- Diana Busjra Brown
- Nancy Bryan-Schatz
All providers in Sullivan, MO · Family Nurse Practitioner in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 13, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.