Individual provider Active NPI

Vanessa Mondestin, M.D.

  • Pediatrics Physician
  • Saint Louis, MO
National Provider Identifier
1144671868
Registry record updated Nov 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
25MA10558700 Issued in NJ
Practice address
1 Childrens PL
3S34
Saint Louis, MO 63110-1002
Phone
(314) 454-6006
Fax
(314) 454-4102
NPI assigned
Jun 23, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 2, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 25MA10558700 NJ Primary
Pediatrics Physician 208000000X 2016021E05 MO

Addresses

Primary practice location

1 Childrens PL
3S34
Saint Louis, MO 63110-1002

Mailing address

1 Capital Way
Pennington, NJ 08534-2520
Phone (609) 303-4010

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191119002147 NJ Practitioner - Pediatric Medicine 8527490143 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2016021E05MOMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Capital Health Multispecialty Group CurrentSince Oct 1, 2021 Accepting new patients
Emergency Physician Associates of North Jersey P C CurrentSince Apr 1, 2024 Accepting new patients
Robert Wood Johnson University Hospital, Inc Past Accepting new patients
Capital Health System, Inc. Past Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

200 Trenton Rd
Browns Mills, NJ 08015
Phone (609) 893-1200

3131 Princeton Pike
Bldg 5
Lawrenceville, NJ 08648
Phone (609) 844-9661

1 Capital Way
Pennington, NJ 08534
Phone (609) 303-4000

99 Beauvoir Ave
Summit, NJ 07901
Phone (908) 522-2232

750 Brunswick Ave
Trenton, NJ 08638
Phone (609) 394-6000

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/5bb47b8f-8587-42a0-80df-8d4eecf69db3/

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1466640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635811200000",
    "number": "1144671868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CAPITAL WAY",
            "city": "PENNINGTON",
            "state": "NJ",
            "postal_code": "085342520",
            "telephone_number": "609-303-4010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 CHILDRENS PL",
            "address_2": "3S34",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101002",
            "telephone_number": "314-454-6006",
            "fax_number": "314-454-4102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONDESTIN",
        "first_name": "VANESSA",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-06-23",
        "last_updated": "2021-11-02",
        "certification_date": "2021-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "25MA10558700",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2016021E05",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.