Individual provider Active NPI

Stephanie Graham, NP

  • Nurse Practitioner
  • Saint Peters, MO
National Provider Identifier
1306238704
Registry record updated Sep 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
2014038747 Issued in MO
Practice address
201 BJC Saint Peters Dr Ste 200
Saint Peters, MO 63376-3386
Phone
(636) 916-7235
Fax
(636) 916-7236
NPI assigned
Feb 23, 2015
Sex
Female
Sole proprietor
No

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2014038747 MO
Nurse Practitioner 363L00000X 2014038747 MO Primary

Addresses

Primary practice location

201 BJC Saint Peters Dr Ste 200
Saint Peters, MO 63376-3386

Mailing address

PO Box 959354
Saint Louis, MO 63195-9354
Phone (636) 916-7235

Other practice location 1

100 Brevco Plz Ste 107
Lake St Louis, MO 63367-1392
Phone (636) 561-3396

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Health Information Exchange (HIE)

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
I20150513002389 MO Practitioner - Nurse Practitioner 5395065452 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Physician Groups LCGroup PAC ID 3072421254, 526 clinicians

Practice addresses (Care Compare)

1110 Highlands Plaza Dr E
Saint Louis, MO 63110-1351
Phone (314) 273-0195

2630 Hwy K
O Fallon, MO 63368-6624
Phone (636) 240-5454

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2014038747MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Physician Groups LC CurrentSince Feb 1, 2025 Accepting new patients
Physician Groups LC Family Medicine CurrentSince Feb 1, 2025 Accepting new patients
CJW Enterprises, Inc. CurrentSince Mar 31, 2015 Accepting new patients

Locations

100 Brevco Plz
Ste 107
Lake St Louis, MO 63367
Phone (636) 561-3396

2630 Highway K
O Fallon, MO 63368
Phone (636) 240-5454

522 N New Ballas Rd
Ste 199
Saint Louis, MO 63141
Phone (314) 432-2323

9915 Kennerly Rd
Ste J
Saint Louis, MO 63128
Phone (314) 843-4794

201 Bjc Saint Peters Dr
Ste 200
Saint Peters, MO 63376
Phone (636) 916-9615

201 Bjc Saint Peters Dr
Ste 100
Saint Peters, MO 63376
Phone (636) 916-7235

Interoperability endpoints

  • Direct secure messaging: stephaniegraham@ihadv.allscriptsdirect.net

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1424649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758240000000",
    "number": "1306238704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 959354",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631959354",
            "telephone_number": "636-916-7235",
            "fax_number": "636-916-7236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 BJC SAINT PETERS DR STE 200",
            "city": "SAINT PETERS",
            "state": "MO",
            "postal_code": "633763386",
            "telephone_number": "636-916-7235",
            "fax_number": "636-916-7236"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Brevco Plz Ste 107",
            "address_purpose": "LOCATION",
            "city": "Lake St Louis",
            "state": "MO",
            "postal_code": "633671392",
            "country_code": "US",
            "telephone_number": "636-561-3396",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "STEPHANIE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-02-23",
        "last_updated": "2025-09-19",
        "certification_date": "2025-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2014038747",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MO",
            "license": "2014038747",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "201 Bjc Saint Peters Dr Ste 200",
            "city": "Saint Peters",
            "state": "MO",
            "country_code": "US",
            "postal_code": "633763386",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Peters, MO

Sources for this page

Verify at the official NPI Registry.