NPIMap

Individual provider Active NPI

Donna M Wagstaff, MD

  • Family Medicine Physician
  • Saint Louis, MO
National Provider Identifier
1326030586
Registry record updated Apr 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
120005 Issued in MO
Practice address
4438 Telegraph Rd
Saint Louis, MO 63129-3316
Phone
(314) 543-5996
Fax
(314) 543-5958
NPI assigned
Aug 15, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 120005 MO Primary

Addresses

Primary practice location

4438 Telegraph Rd
Saint Louis, MO 63129-3316

Mailing address

4438 Telegraph Rd
Saint Louis, MO 63129-3316
Phone (314) 543-5996

Other identifiers 1

IdentifierTypeStateIssuer
156880001OtherMOMEDICARE PTAN #

Other names 1

  • Donna M Andres Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, IL2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040824000084 MO Practitioner - Family Practice 3274441613 Reassigns benefits to 1 organization
I20050922000889 IL Practitioner - Family Practice 3274441613 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Saint Louis University School of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinic East CommunitiesGroup PAC ID 7214827922, 573 clinicians

Practice addresses (Care Compare)

5758 Telegraph Rd
Oakville, MO 63129-4244
Phone (314) 543-5996

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
120005MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Specialists Services-Illinois LLC CurrentSince Feb 14, 2022 Accepting new patients
Mercy Clinic East Communities Family Medicine CurrentSince Jan 1, 2020 Accepting new patients
Mercy Clinic Illinois, LLC CurrentSince Nov 13, 2019 Accepting new patients
Mercy Clinic East Communities Family Medicine CurrentSince Jan 1, 2020 Accepting new patients
PC Associates, LLC Family Medicine Past Accepting new patients
Mercy Hospital Springfield Past Accepting new patients
Mercy Clinic Springfield Communities Family Medicine Past Accepting new patients

Locations

1019 Valmeyer Rd
Columbia, IL 62236
Phone (314) 543-5244

621 S New Ballas Rd
Ste 189A
Saint Louis, MO 63141
Phone (314) 251-6335

621 S New Ballas Rd
Ste 4017B
Saint Louis, MO 63141
Phone (314) 872-9192

5425 Southfield Ctr
Saint Louis, MO 63123
Phone (314) 543-5258

4438 Telegraph Rd
Saint Louis, MO 63129
Phone (314) 543-5996

Interoperability endpoints

  • Direct secure messaging: dwagstaff992393@directc.mercy.net

Organizations & group practices 7

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 4

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": "1124064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554768000000",
    "number": "1326030586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4438 TELEGRAPH RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631293316",
            "telephone_number": "314-543-5996",
            "fax_number": "314-543-5958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4438 TELEGRAPH RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631293316",
            "telephone_number": "314-543-5996",
            "fax_number": "314-543-5958"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGSTAFF",
        "first_name": "DONNA",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-15",
        "last_updated": "2019-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "120005",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN #",
            "identifier": "156880001",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DONNA",
            "last_name": "ANDRES",
            "middle_name": "M",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.