Individual provider Active NPI

Andrea Puricelli, RD, LDN, CLC

  • Registered Dietitian
  • Saint Louis, MO
National Provider Identifier
1164906079
Registry record updated Sep 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
Practice address
6121 N Hanley Rd
Saint Louis, MO 63134-2003
Phone
(314) 615-0553
Fax
(314) 615-0880
NPI assigned
Sep 18, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X Primary

Addresses

Primary practice location

6121 N Hanley Rd
Saint Louis, MO 63134-2003

Mailing address

9848 Allendale Dr
Saint Louis, MO 63123-6443

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240715003727 TX Practitioner - Registered Dietitian Or Nutrition Professional 4486199312 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Registered Dietitian Or Nutrition Professional
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Nourish, Inc.Group PAC ID 1557724937, 288 clinicians

Practice addresses (Care Compare)

3724 Jefferson St
Suite 104
Austin, TX 78731-6204
Phone (512) 693-7045

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Nourish, Inc. Dietitian, Registered CurrentSince Jun 3, 2024 Accepting new patients

Locations

260 Peachtree St NW
Ste 2200
Atlanta, GA 30303
Phone (669) 231-6870

500 Westover Dr
Sanford, NC 27330
Phone (478) 766-4000

3724 Jefferson St
Ste 104
Austin, TX 78731
Phone (512) 399-9039

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.

NPI Registry JSON

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

{
    "created_epoch": "1537228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537228800000",
    "number": "1164906079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9848 ALLENDALE DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631236443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6121 N HANLEY RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631342003",
            "telephone_number": "314-615-0553",
            "fax_number": "314-615-0880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PURICELLI",
        "first_name": "ANDREA",
        "credential": "RD, LDN, CLC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-18",
        "last_updated": "2018-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.