Individual provider Active NPI

Kristy Wienstroer, WHNP

  • Women's Health Nurse Practitioner
  • Shiloh, IL
National Provider Identifier
1124530340
Registry record updated Oct 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Women's Health Nurse PractitionerTaxonomy code 363LW0102X
License
209016709 Issued in IL
Practice address
1191 Fortune Blvd
Shiloh, IL 62269-7377
Phone
(618) 206-6101
NPI assigned
Oct 27, 2017
Last updated
Oct 27, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Women's Health Nurse Practitioner 363LW0102X 2017025486 MO
Women's Health Nurse Practitioner 363LW0102X 209016709 IL Primary

Addresses

Primary practice location

1191 Fortune Blvd
Shiloh, IL 62269-7377

Mailing address

1191 Fortune Blvd
Shiloh, IL 62269-7377
Phone (618) 206-6101

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, IL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20171128002632 MO Practitioner - Nurse Practitioner 3577820604 Reassigns benefits to 2 organizations
I20171212003145 IL Practitioner - Nurse Practitioner 3577820604 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2017025486MOMDWomen's Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
SSM Cardinal Glennon Childrens Hospital CurrentSince Oct 15, 2018 Accepting new patients
SSM Health Care St Louis CurrentSince Oct 23, 2017 Accepting new patients
SSM Health Care St. Louis CurrentSince Oct 23, 2017 Accepting new patients
SSM Cardinal Glennon Children's Hospital CurrentSince Oct 15, 2018 Accepting new patients
SSM Health Care St. Louis Past Accepting new patients

Locations

900 E Walnut St
Ste 5
Carbondale, IL 62901
Phone (618) 519-9182

7344 Solutions Ctr
Chicago, IL 60677
Phone (314) 989-6189

1191 Fortune Blvd
Ste 1
Shiloh, IL 62269
Phone (618) 206-6101

1015 Bowles Ave
Fenton, MO 63026
Phone (636) 496-2000

1465 S Grand Blvd
Saint Louis, MO 63104
Phone (314) 268-4070

Interoperability endpoints

  • Direct secure messaging: kweinstroer14833@direct-ehr-ssmhc.com

Organizations & group practices 5

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": "1509062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1509062400000",
    "number": "1124530340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1191 FORTUNE BLVD",
            "city": "SHILOH",
            "state": "IL",
            "postal_code": "622697377",
            "telephone_number": "618-206-6101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1191 FORTUNE BLVD",
            "city": "SHILOH",
            "state": "IL",
            "postal_code": "622697377",
            "telephone_number": "618-206-6101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIENSTROER",
        "first_name": "KRISTY",
        "credential": "WHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-27",
        "last_updated": "2017-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "MO",
            "license": "2017025486",
            "primary": false
        },
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "IL",
            "license": "209016709",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shiloh, IL

Sources for this page

Verify at the official NPI Registry.