Integrated Care Professionals of Missouri, LLC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

INTEGRATED CARE PROFESSIONALS OF MISSOURI, LLC

Practice address

4625 Lindell Blvd Ste 214
Saint Louis, MO 63108-3725

Phone

(601) 258-7154

NPI assigned

Jan 10, 2020

Organization subpart

No

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

Authorized official

Name

Rodney Thomason

Title

Authorized Official

Phone

(501) 406-6180

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael P Cacciola, PA-C

  • Surgical Physician Assistant
  • Manchester, NH
  • NPI 1164812418
  NPD (past)

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

{
    "created_epoch": "1578614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578614400000",
    "number": "1144860875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3457",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722033457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4625 LINDELL BLVD STE 214",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631083725",
            "telephone_number": "601-258-7154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED CARE PROFESSIONALS OF MISSOURI, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-10",
        "last_updated": "2020-01-10",
        "certification_date": "2020-01-10",
        "status": "A",
        "authorized_official_last_name": "THOMASON",
        "authorized_official_first_name": "RODNEY",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "501-406-6180"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nurse Practitioner in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2020; 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.