Individual provider Active NPI

Georgina Fuentes Velasquez, NP

  • Family Nurse Practitioner
  • Saint Louis, MO
National Provider Identifier
1285234799
Registry record updated Sep 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
2020026943 Issued in MO
Practice address
12101 Woodcrest Executive Dr Ste 102
Saint Louis, MO 63141-5047
Phone
(800) 427-1902
NPI assigned
Oct 26, 2020
Last updated
Sep 19, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 19, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 2020026943 MO Primary

Addresses

Primary practice location

12101 Woodcrest Executive Dr Ste 102
Saint Louis, MO 63141-5047

Mailing address

333 N Summit St FL 15
Toledo, OH 43604-2615
Phone (800) 427-1902

Other practice location 1

3009 N Ballas Rd Ste 383C
Saint Louis, MO 63131-2324
Phone (314) 305-1447

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
I20201116002513 MO Practitioner - Nurse Practitioner 6800207242 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fairview Heights Medical Group SCGroup PAC ID 6800784083, 448 clinicians

Practice addresses (Care Compare)

11133 Dunn Rd
Saint Louis, MO 63136-6163
Phone (314) 653-5643

11155 Dunn Rd
Suite 109N
Saint Louis, MO 63136-6148
Phone (314) 953-8799

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2020026943MOMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Heights Medical Group SC CurrentSince Aug 1, 2024 Accepting new patients
HCR Manorcare Medical Services of Florida LLC CurrentSince Nov 16, 2020 Accepting new patients
Fairview Heights Medical Group SC CurrentSince Aug 1, 2024 Accepting new patients

Locations

1200 Graham Rd
Florissant, MO 63031
Phone (314) 383-6555

11155 Dunn Rd
Ste 109N
Saint Louis, MO 63136
Phone (314) 837-3784

3009 N Ballas Rd
Ste 383C
Saint Louis, MO 63131
Phone (314) 305-1447

660 Mason Ridge Center Dr
Ste 300
Saint Louis, MO 63141
Phone (314) 463-6950

333 N Summit St
Fl 15
Toledo, OH 43604
Phone (419) 252-5530

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.

Hospital & facility affiliations 2

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": "1603670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758240000000",
    "number": "1285234799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 N SUMMIT ST FL 15",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436042615",
            "telephone_number": "800-427-1902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12101 WOODCREST EXECUTIVE DR STE 102",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631415047",
            "telephone_number": "800-427-1902"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3009 N Ballas Rd Ste 383C",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631312324",
            "country_code": "US",
            "telephone_number": "314-305-1447",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FUENTES VELASQUEZ",
        "first_name": "GEORGINA",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-26",
        "last_updated": "2025-09-19",
        "certification_date": "2025-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2020026943",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.