Individual provider Active NPI

Abby Marissa Nelson, PA

  • Physician Assistant
  • Saint Louis, MO
National Provider Identifier
1306302740
Registry record updated Apr 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2019006015 Issued in MO
Practice address
12634 Olive Blvd
Dept Orthopaedic Surgery
Saint Louis, MO 63141-6337
Phone
(314) 996-8099
Fax
(314) 996-8132
NPI assigned
Feb 11, 2019
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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2019006015 MO Primary

Addresses

Primary practice location

12634 Olive Blvd
Dept Orthopaedic Surgery
Saint Louis, MO 63141-6337

Mailing address

PO Box 7412011
Chicago, IL 60674-2011
Phone (314) 996-8099

Other identifiers 1

IdentifierTypeStateIssuer
220072978MedicaidMO

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
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
I20191230001497 MO Practitioner - Physician Assistant 5294169223 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Saint Louis University School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Washington UniversityGroup PAC ID 9830008770, 2,968 clinicians

Practice addresses (Care Compare)

12634 Olive Blvd
Saint Louis, MO 63141-6337
Phone (314) 996-8080

4921 Parkview PL
Saint Louis, MO 63110-1032
Phone (314) 514-3500

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.94 of 100Reported as group
Quality
68.52
Promoting interoperability
100
Improvement activities
40
Cost
72.22

Merit-based Incentive Payment System (MIPS)

Final score
84.2 of 100Reported as group
Quality
71.6
Promoting interoperability
100
Improvement activities
40
Cost
75.75

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2019006015MOMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Washington University CurrentSince Nov 8, 2024 Accepting new patients
SSM Health Care Group CurrentSince Sep 1, 2023 Accepting new patients
Washington University CurrentSince Nov 8, 2024 Accepting new patients
Washington University Past Accepting new patients

Locations

12634 Olive Blvd
Saint Louis, MO 63141
Phone (314) 434-0600

3635 Vista Ave
Saint Louis, MO 63110
Phone (314) 577-8022

10101 Woodfield Ln
Saint Louis, MO 63132
Phone (608) 280-4647

4921 Parkview Pl
Ste 6A6B12A
Saint Louis, MO 63110
Phone (314) 747-2551

Organizations & group practices 6

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 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": "1549843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744848000000",
    "number": "1306302740",
    "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": "314-996-8099",
            "fax_number": "314-996-8132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12634 OLIVE BLVD",
            "address_2": "DEPT ORTHOPAEDIC SURGERY",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631416337",
            "telephone_number": "314-996-8099",
            "fax_number": "314-996-8132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "ABBY",
        "middle_name": "MARISSA",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-11",
        "last_updated": "2025-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2019006015",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "220072978",
            "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": "12634 Olive Blvd",
            "address_2": "Dept Orthopaedic Surgery",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631416337",
            "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.