Organization Active NPI

Purely Pediatrics LLC

  • Pediatrics Physician
  • Town & Country, MO
National Provider Identifier
1174069900
Registry record updated Apr 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PURELY PEDIATRICS LLC
Practice address
13001 N Outer Forty Rd
Suite 330
Town & Country, MO 63017
Phone
(314) 454-5500
Fax
(314) 454-5501
NPI assigned
Jan 18, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2025

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

Authorized official

Name
Ms. Cathy Eghigian
Title
Senior Director Wu Managed Care
Phone
(314) 273-0770

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

13001 N Outer Forty Rd
Suite 330
Town & Country, MO 63017

Mailing address

PO Box 7412017
Chicago, IL 60674-2011
Phone (314) 454-5500

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170322002906 MO Part B Supplier - Clinic/Group Practice 7012292642 Receives reassigned benefits from 3 practitioners
Practice locations: Town and Country, MO

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D2126911Purely Pediatrics, LLC13001 North Outer Forty Road Ste 330, Town and Country, MO 63017Certificate of waiverMar 6, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1484697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745884800000",
    "number": "1174069900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7412017",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606742011",
            "telephone_number": "314-454-5500",
            "fax_number": "314-454-5501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13001 N OUTER FORTY RD",
            "address_2": "SUITE 330",
            "city": "TOWN & COUNTRY",
            "state": "MO",
            "postal_code": "63017",
            "telephone_number": "314-454-5500",
            "fax_number": "314-454-5501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PURELY PEDIATRICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-18",
        "last_updated": "2025-04-29",
        "certification_date": "2025-04-29",
        "status": "A",
        "authorized_official_last_name": "EGHIGIAN",
        "authorized_official_first_name": "CATHY",
        "authorized_official_title_or_position": "SENIOR DIRECTOR WU MANAGED CARE",
        "authorized_official_telephone_number": "314-273-0770",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Town & Country, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2025; 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.