Individual provider Active NPI

Tracy M Olson, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Saint Louis, MO
National Provider Identifier
1114638566
Registry record updated Dec 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
2022046847 Issued in MO
Practice address
11477 Olde Cabin Rd
Saint Louis, MO 63141-7130
Phone
(314) 569-1717
NPI assigned
Dec 7, 2022
Last updated
Dec 7, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 2022046847 MO Primary

Addresses

Primary practice location

11477 Olde Cabin Rd
Saint Louis, MO 63141-7130

Mailing address

17922 Homestead Bluffs Dr
Wildwood, MO 63005-8435
Phone (636) 233-7418

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
I20230222001254 MO Practitioner - Nurse Practitioner 4880067800 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Serenity Health LLCGroup PAC ID 3375920861, 22 clinicians
One Behavioral of MissouriGroup PAC ID 6204313364, 19 clinicians

Practice addresses (Care Compare)

4905 Mexico Rd
Suite 400
Saint Peters, MO 63376-1601
Phone (314) 590-3721

5000 Cedar Plaza Pkwy
Suite 320
Saint Louis, MO 63128-3841
Phone (314) 200-1366

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2022046847MOMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Serenity Health LLC CurrentSince Jan 1, 2023 Accepting new patients
One Behavioral of Missouri CurrentSince Jan 1, 2026 Accepting new patients
St. Louis Internal Medicine Inc PastSince Jan 1, 2023 Accepting new patients

Locations

11709 Old Ballas Rd
Ste 105
Saint Louis, MO 63141
Phone (314) 993-6070

5000 Cedar Plaza Pkwy
Ste 320
Saint Louis, MO 63128
Phone (669) 900-9251

5000 Cedar Plaza Pkwy
Ste 350
Saint Louis, MO 63128
Phone (314) 843-4333

4905 Mexico Rd
Ste 400
Saint Peters, MO 63376
Phone (314) 862-4840

5000 Cedar Plaza Pkwy
Ste 300
Sappington, MO 63128
Phone (314) 647-9797

Interoperability endpoints

  • Direct secure messaging: serenityhealth.tracyolson@154693.advancedmd-direct.com

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1670371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670371200000",
    "number": "1114638566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17922 HOMESTEAD BLUFFS DR",
            "city": "WILDWOOD",
            "state": "MO",
            "postal_code": "630058435",
            "telephone_number": "636-233-7418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11477 OLDE CABIN RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631417130",
            "telephone_number": "314-569-1717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLSON",
        "first_name": "TRACY",
        "middle_name": "M",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-07",
        "last_updated": "2022-12-07",
        "certification_date": "2022-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MO",
            "license": "2022046847",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.