Mercy Clinic East Communities
Organization Active NPI Multi-Specialty Clinic/Center · Wildwood, MO
NPI 1164857397 · NPPES record last updated Apr 25, 2025
Key facts
- NPI
- 1164857397
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Multi-Specialty Clinic/Center 261QM1300X
- Legal business name
- MERCY CLINIC EAST COMMUNITIES
- Practice address
- 16555 Manchester Rd Ste 110
Wildwood, MO 63040-1220 - Phone
- (636) 405-3155
- Fax
- (636) 405-3162
- NPI assigned
- Sep 6, 2013
- Organization subpart
- Yes
- Parent organization (as reported)
- MERCY HEALTH EAST COMMUNITIES
Authorized official
- Name
- Kerry Dunger
- Title
- Executive Director - Finance
- Phone
- (314) 364-3707
Other NPIs on the same Medicare enrollment 8
Practitioners 141
-
Erin S Adams, RN, APRN, CPNP
-
Kelly J Bain, M.D.
-
Claire Bartusch, PA
-
Christie A Bayer, MD
-
Shafia M Bhutto, M.D.
-
Barbara L Blaue, WHNP
-
Monica Lynn Board, RN, FNP
-
Craig W Boyd, MD
-
David M Brown, MD
-
Julie E Busch, MD
-
Ann Marie Byrd, RN, MSN, FNP-BC
-
Christina Lee Byron, M.D.
-
Edward Chun-Kuan Chen, M.D.
-
Sarah Z. Cole, D.O.
-
Philip G Conway, MD
-
Peter G Danis, MD
-
Misty Crider Day, M.D.
-
Devin Ericson, MMS, PA-C
-
Mark A Faron, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 26D1007464 | Mercy Clinic East Communities | Certificate of waiver | Jun 24, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070521000006 | MO | Part B Supplier - Clinic/Group Practice | 7214827922 |
Receives reassigned benefits from 780 practitioners 4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment |
| O20070521000058 | MO | Part B Supplier - Clinic/Group Practice | 7214827922 |
Receives reassigned benefits from 211 practitioners 7 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Washington, MO; Warrenton, MO; Union, MO; Troy, MO; Sullivan, MO; Saint Clair, MO; Pacific, MO; New Haven, MO… |
National Provider Directory
Locations
1400 US Highway 61
Ste 340
Crystal Cty, MO 63028
Phone (314) 937-1545
2223 Technology Dr
Ste 35
O Fallon, MO 63368
Phone (636) 561-5999
12348 Old Tesson Rd
Ste 250
Saint Louis, MO 63128
Phone (314) 272-2727
621 S New Ballas Rd
Ste 507A
Saint Louis, MO 63141
Phone (314) 251-6800
621 S New Ballas Rd
Ste 4017B
Saint Louis, MO 63141
Phone (314) 872-9192
12680 Olive Blvd
Ste 300
Saint Louis, MO 63141
Phone (314) 251-8888
12348 Old Tesson Rd
Ste 240
Saint Louis, MO 63128
Phone 3144673900 ext. 284
621 S New Ballas Rd
Ste 4005B
Saint Louis, MO 63141
Phone (314) 251-5016
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Multi-Specialty Clinic/Center | 261QM1300X | Yes |
Addresses
Primary practice location
16555 Manchester Rd Ste 110
Wildwood, MO 63040-1220
Mailing address
16555 Manchester Rd Ste 110
Wildwood, MO 63040-1220
Phone (636) 405-3155
Other practice location 1
901 Patients First Dr Ste 1200
Washington, MO 63090-4700
Phone (636) 390-1777
Other practice location 2
4525 Mid Rivers Mall Dr Ste 10
Cottleville, MO 63376-2820
Phone (636) 229-3350
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164857397 | Medicaid | MO |
Other names
- Mercy Clinic Convenient Care
Other providers in Wildwood, MO
- Julie Kathleen McDonald
- Jennifer McDonnell
- Kayla McWilliams
- Lauren Alison Medina
- Jacquelyn M Mellis
- Mercy Pharmacy Services LLC
- Metro West Fire Protection District of St Louis City
- Edmond James Meyer
- Michael L Masucci DC LLC
- Midwest Counseling & Consulting, LLC
All providers in Wildwood, MO · Multi-Specialty Clinic/Center in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 25, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.