Individual provider Active NPI

Heidi Elaine Roeder, PA

  • Physician Assistant
  • Saint Louis, MO
National Provider Identifier
1154714202
Registry record updated Nov 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2015006471 Issued in MO
Practice address
621 S New Ballas Rd Ste 3005B
Saint Louis, MO 63141-8266
Phone
(314) 251-7070
Fax
(314) 251-7071
NPI assigned
Mar 13, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2015006471 MO Primary

Addresses

Primary practice location

621 S New Ballas Rd Ste 3005B
Saint Louis, MO 63141-8266

Mailing address

621 S New Ballas Rd Ste 3005B
Saint Louis, MO 63141-8266
Phone (314) 251-7070

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
I20161201000414 MO Practitioner - Physician Assistant 0143500579 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinic Trauma and General Surgery LLCGroup PAC ID 1658320700, 44 clinicians

Practice addresses (Care Compare)

621 S New Ballas Rd
Suite 3005B
Saint Louis, MO 63141-8266
Phone (314) 251-7070

621 S New Ballas Rd
Suite 560a
Saint Louis, MO 63141-8261
Phone (314) 569-6440

701 S New Ballas Rd
Suite 510
Saint Louis, MO 63141-8726
Phone (314) 251-7070

Hospital & facility affiliations

  • Mercy Hospital St Louis Hospital, Saint Louis, MO, CCN 260020

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2015006471MOMDPhysician Assistant

Organizations & group practices 1

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1426204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701216000000",
    "number": "1154714202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 S NEW BALLAS RD STE 3005B",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418266",
            "telephone_number": "314-251-7070",
            "fax_number": "314-251-7071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 S NEW BALLAS RD STE 3005B",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418266",
            "telephone_number": "314-251-7070",
            "fax_number": "314-251-7071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROEDER",
        "first_name": "HEIDI",
        "middle_name": "ELAINE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-13",
        "last_updated": "2023-11-29",
        "certification_date": "2023-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2015006471",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.