Individual provider Active NPI

Mary Ann Von Feldt, ANP

  • Adult Health Nurse Practitioner
  • Saint Louis, MO
National Provider Identifier
1265476543
Registry record updated Apr 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
117385 Issued in MO
Practice address
2325 Dougherty Ferry Rd
Suite 205
Saint Louis, MO 63122-3356
Phone
(314) 966-9888
Fax
(314) 966-5957
NPI assigned
Jun 16, 2006
Last updated
Apr 29, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 117385 MO Primary

Addresses

Primary practice location

2325 Dougherty Ferry Rd
Suite 205
Saint Louis, MO 63122-3356

Mailing address

2325 Dougherty Ferry Rd
Suite 205
Saint Louis, MO 63122-3356
Phone (314) 966-9888

Other identifiers 1

IdentifierTypeStateIssuer
425451101MedicaidMO

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
I20180515001454 MO Practitioner - Nurse Practitioner 1355605650 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Bi-State Cardiovascular Consultant PC CurrentSince Jan 11, 2020 Accepting new patients
Cardiology Diagnostics, LTD. Past Accepting new patients
Cardiology Diagnostics, LTD. Past Accepting new patients

Locations

2705 Dougherty Ferry Rd
Saint Louis, MO 63122
Phone (314) 394-3319

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/9887/brand/1/csg/1/fhir/r4
  • FHIR API: https://fhir4.healow.com/fhir/r4/GFDECD

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209427200000",
    "number": "1265476543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2325 DOUGHERTY FERRY RD",
            "address_2": "SUITE 205",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631223356",
            "telephone_number": "314-966-9888",
            "fax_number": "314-966-5957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2325 DOUGHERTY FERRY RD",
            "address_2": "SUITE 205",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631223356",
            "telephone_number": "314-966-9888",
            "fax_number": "314-966-5957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VON FELDT",
        "first_name": "MARY",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-16",
        "last_updated": "2008-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MO",
            "license": "117385",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "425451101",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.