NPIMap

Organization Active NPI

Lifetime Psychiatry LLC

  • Psychiatry Physician
  • Saint Peters, MO
National Provider Identifier
1225613557
Registry record updated Mar 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
LIFETIME PSYCHIATRY LLC
Practice address
5700 Mexico Rd Ste 8
Saint Peters, MO 63376-1667
Phone
(636) 477-6464
Fax
(636) 410-9291
NPI assigned
Mar 17, 2021
Last updated
Mar 17, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2021

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

Authorized official

Name
Karrie Copeland
Title
Practice Manager
Phone
(636) 477-6464

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X NU Primary

Addresses

Primary practice location

5700 Mexico Rd Ste 8
Saint Peters, MO 63376-1667

Mailing address

5700 Mexico Rd Ste 8
Saint Peters, MO 63376-1667
Phone (636) 477-6464

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210825001437 MO Part B Supplier - Clinic/Group Practice 5496150799 Receives reassigned benefits from 7 practitioners
Practice locations: Saint Peters, MO

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1615939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615939200000",
    "number": "1225613557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5700 MEXICO RD STE 8",
            "city": "SAINT PETERS",
            "state": "MO",
            "postal_code": "633761667",
            "telephone_number": "636-477-6464",
            "fax_number": "636-410-9291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5700 MEXICO RD STE 8",
            "city": "SAINT PETERS",
            "state": "MO",
            "postal_code": "633761667",
            "telephone_number": "636-477-6464",
            "fax_number": "636-410-9291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFETIME PSYCHIATRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-17",
        "last_updated": "2021-03-17",
        "certification_date": "2021-03-17",
        "status": "A",
        "authorized_official_last_name": "COPELAND",
        "authorized_official_first_name": "KARRIE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "636-477-6464"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Peters, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.