Elite Psychiatric Services, LLC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

2004001640 Issued in MO

Legal business name

ELITE PSYCHIATRIC SERVICES, LLC

Practice address

11133 Dunn Rd
Saint Louis, MO 63136-6119

Phone

(314) 653-5370

Fax

(314) 653-5399

NPI assigned

Jul 11, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Shannon Michelle Jennings, M.D.

Title

Physician

Phone

(636) 484-0632

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nancy Lubowitz

  • Clinical Social Worker
  • Saint Louis, MO
  • NPI 1366658379
  NPD (past)
• Gary M Morse, PH.D.

  • Clinical Psychologist
  • Saint Louis, MO
  • NPI 1417966300
  NPD (past)
• Gerald M Baltz, DNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Los Angeles, CA
  • NPI 1427290030
  NPD (past)
• Ann Mirette Kirby, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Omaha, NE
  • NPI 1154644870
  NPD (past)

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

{
    "created_epoch": "1184112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285113600000",
    "number": "1144428137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1836 LACKLAND HILL PKWY",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631463572",
            "telephone_number": "314-872-1439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11133 DUNN RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631366119",
            "telephone_number": "314-653-5370",
            "fax_number": "314-653-5399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE PSYCHIATRIC SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-11",
        "last_updated": "2010-09-22",
        "status": "A",
        "authorized_official_last_name": "JENNINGS",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "636-484-0632",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MO",
            "license": "2004001640",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "504045402",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE GROUP#",
            "identifier": "DF9548",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elite in-Home Services LLC
• Elite Loving Care
• Elite Medical Innovations
• Elite Mens Health of St Louis
• Elite Physical Therapy LLC
• Elite Surgical Assisting LLC
• Elite Telehealth Care LLC
• Elizabeth F. Pribor, M.D., P.C.
• Marinella Elizaga
• Santiago Elizondo Benedetto

• Psychiatry Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Psychiatry Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2010; 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.