Individual provider Active NPI

Amanda Johnson, AGACNP

  • Acute Care Nurse Practitioner
  • Chesterfield, MO
National Provider Identifier
1245052117
Registry record updated Oct 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
2024013896 Issued in MO
Practice address
232 S Woods Mill Rd
Chesterfield, MO 63017-3485
Phone
(314) 434-1500
NPI assigned
Oct 30, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 2024013896 MO Primary

Addresses

Primary practice location

232 S Woods Mill Rd
Chesterfield, MO 63017-3485

Mailing address

1065 Timberline Dr
Fenton, MO 63026-4557

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
I20241220000248 MO Practitioner - Nurse Practitioner 7810424405 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physician Specialists of St Lukes LLCGroup PAC ID 1557366960, 77 clinicians

Practice addresses (Care Compare)

232 S Woods Mill Rd
Chesterfield, MO 63017-3406
Phone (314) 434-1500

Hospital & facility affiliations

  • St Lukes Hospital Hospital, Chesterfield, MO, CCN 260179

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
2024013896MOMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Physician Specialists of St Lukes LLC CurrentSince Dec 15, 2024 Accepting new patients
Emergency Physicians of St. Luke'S, LLC Past Accepting new patients

Locations

121 Saint Lukes Center Dr
Chesterfield, MO 63017
Phone (314) 434-3278

232 S Woods Mill Rd
Town and Country, MO 63017
Phone (314) 205-6030

Organizations & group practices 2

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 1

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": "1730246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730246400000",
    "number": "1245052117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1065 TIMBERLINE DR",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630264557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "232 S WOODS MILL RD",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630173485",
            "telephone_number": "314-434-1500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "AMANDA",
        "credential": "AGACNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-30",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MO",
            "license": "2024013896",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chesterfield, MO

Sources for this page

Verify at the official NPI Registry.