Individual provider Active NPI

Jenny Lynn Miele, MD

  • Pediatrics Physician
  • Saint Charles, MO
National Provider Identifier
1114195518
Registry record updated Apr 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
2008009820 Issued in MO
Practice address
11 Garvey Pkwy
Saint Charles, MO 63303-5614
Phone
(636) 441-7280
Fax
(636) 939-9208
NPI assigned
Feb 19, 2008
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
Pediatrics Physician 208000000X 2008009820 MO Primary

Addresses

Primary practice location

11 Garvey Pkwy
Saint Charles, MO 63303-5614

Mailing address

PO Box 7412031
Chicago, IL 60674-2031
Phone (636) 441-7280

Other identifiers 1

IdentifierTypeStateIssuer
200003478MedicaidMO

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
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2008009820MOMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Washington University CurrentSince May 4, 2025 Accepting new patients
Washington University Past Accepting new patients

Locations

11 Garvey Pkwy
Saint Charles, MO 63303
Phone (636) 441-7280

1660 W Meyer Rd
Wentzville, MO 63385
Phone (636) 332-6663

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": "1203379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744934400000",
    "number": "1114195518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7412031",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606742031",
            "telephone_number": "636-441-7280",
            "fax_number": "636-939-9208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 GARVEY PKWY",
            "city": "SAINT CHARLES",
            "state": "MO",
            "postal_code": "633035614",
            "telephone_number": "636-441-7280",
            "fax_number": "636-939-9208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIELE",
        "first_name": "JENNY",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-19",
        "last_updated": "2025-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2008009820",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200003478",
            "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": "11 Garvey Pkwy",
            "city": "Saint Charles",
            "state": "MO",
            "country_code": "US",
            "postal_code": "633035614",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Charles, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.