Individual provider Active NPI

Kelsie Marie Mentz, ACNP

  • Nurse Practitioner
  • Saint Louis, MO
National Provider Identifier
1306214697
Registry record updated Apr 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
2016001344 Issued in MO
Practice address
4500 Forest Park Ave
Dept Neurological Surgery, Ste 1B
Saint Louis, MO 63108-2114
Phone
(314) 362-3577
Fax
(314) 362-2107
NPI assigned
Sep 3, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 2016001344 MO
Nurse Practitioner 363L00000X 2016001344 MO Primary

Addresses

Primary practice location

4500 Forest Park Ave
Dept Neurological Surgery, Ste 1B
Saint Louis, MO 63108-2114

Mailing address

PO Box 7412011
Chicago, IL 60674-2011
Phone (314) 362-3577

Other identifiers 1

IdentifierTypeStateIssuer
420028400MedicaidMO

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Washington University

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, IL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20160308002544 MO Practitioner - Nurse Practitioner 1759687387 Reassigns benefits to 3 organizations
I20170221002624 IL Practitioner - Nurse Practitioner 1759687387 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Washington UniversityGroup PAC ID 9830008770, shared by 49 NPIs, 2,968 clinicians
Aging Well Health Care, LLCGroup PAC ID 1153232038, 236 clinicians

Practice addresses (Care Compare)

1 Barnes Jew Hosp PLZ
Saint Louis, MO 63110-1003
Phone (314) 747-3000

7212 Balson Ave
Saint Louis, MO 63130-3001

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2016001344MOMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Methodist Medical Center of Illinois CurrentSince Feb 27, 2017 Accepting new patients
Methodist Medical Center of Illinois Current Accepting new patients
Proctor Health Systems Current Accepting new patients
Washington University CurrentSince Feb 1, 2016 Accepting new patients
Proctor Health Systems CurrentSince Feb 27, 2017 Accepting new patients
Washington University CurrentSince Sep 27, 2024 Accepting new patients
Washington University Physicians in Illinois, Inc Current Accepting new patients
Washington University Physicians in Illinois, Inc. CurrentSince Sep 1, 2025 Accepting new patients
Methodist Medical Center of Illinois Nurse Practitioner CurrentSince Feb 27, 2017 Accepting new patients
Washington University Physicians in Illinois, Inc CurrentSince Sep 1, 2025 Accepting new patients
Proctor Health Systems CurrentSince Feb 27, 2017 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

1506 W Garfield Ave
Bartonville, IL 61607
Phone (309) 697-2416

4700 Memorial Dr
Ste 220
Belleville, IL 62226
Phone (618) 212-6620

4700 Memorial Dr
Ste 230
Belleville, IL 62226
Phone (618) 212-4414

2535 E Washington St
East Peoria, IL 61611
Phone (309) 694-6464

112 NE Crescent Ave
Peoria, IL 61606
Phone (309) 680-2402

3915 Barring Trce
Peoria, IL 61615
Phone (309) 689-3030

5401 N Knoxville Ave
Ste 400
Peoria, IL 61614
Phone (309) 691-6610

815 Main St
Ste A
Peoria, IL 61602
Phone (309) 672-4986

120 NE Glen Oak Ave
Ste 400
Peoria, IL 61603
Phone (309) 671-3519

221 NE Glen Oak Ave
Peoria, IL 61636
Phone (309) 672-4281

1120 E War Memorial Dr
Peoria Hts, IL 61616
Phone (309) 685-1774

4500 Memorial Dr
Swansea, IL 62226
Phone (618) 233-7750

4921 Parkview Pl
Fl 6
Saint Louis, MO 63110
Phone (256) 606-4529

4921 Parkview Pl
Ste 5C
Saint Louis, MO 63110
Phone (314) 286-2635

660 S Euclid Ave
#8054
Saint Louis, MO 63110
Phone (314) 286-1045

660 S Euclid Ave
Saint Louis, MO 63110

660 S Euclid Ave
#C
Saint Louis, MO 63110

3015 N Ballas Rd
Saint Louis, MO 63131
Phone (314) 996-5330

4921 Parkview Pl
Ste 6B6C
Saint Louis, MO 63110

1 Barnes Hsp Plz
Saint Louis, MO 63110
Phone (314) 273-4966

1 Barnes Jewish Hospital Plz
Saint Louis, MO 63110
Phone (314) 362-1700

4500 Forest Park Ave
Ste 1B
Saint Louis, MO 63108

660 S Euclid Ave
#8015
Saint Louis, MO 63110
Phone (314) 286-1018

100 Entrance Way
Saint Peters, MO 63376
Phone (363) 916-7140

Organizations & group practices 15

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.

View all 15

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": "1441238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744848000000",
    "number": "1306214697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7412011",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606742011",
            "telephone_number": "314-362-3577",
            "fax_number": "314-362-2107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 FOREST PARK AVE",
            "address_2": "DEPT NEUROLOGICAL SURGERY, STE 1B",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631082114",
            "telephone_number": "314-362-3577",
            "fax_number": "314-362-2107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENTZ",
        "first_name": "KELSIE",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "ACNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-03",
        "last_updated": "2025-04-17",
        "certification_date": "2021-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MO",
            "license": "2016001344",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MO",
            "license": "2016001344",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "420028400",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "4500 Forest Park Ave",
            "address_2": "Dept Neurological Surgery, Ste 1B",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631082114",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.