Individual provider Active NPI

Alyssa McLellan, CPNP-PC

  • Pediatric Nurse Practitioner
  • Saint Louis, MO
National Provider Identifier
1326803511
Registry record updated Feb 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
2024006163 Issued in MO
Practice address
1465 S Grand Blvd
Saint Louis, MO 63104-1003
Phone
(314) 577-5666
NPI assigned
Feb 16, 2024
Last updated
Feb 16, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 2024006163 MO Primary

Addresses

Primary practice location

1465 S Grand Blvd
Saint Louis, MO 63104-1003

Mailing address

1465 S Grand Blvd
Saint Louis, MO 63104-1003

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
I20240530000166 MO Practitioner - Nurse Practitioner 9133561640 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Saint Louis University School of Medicine, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SSM Health Care St LouisGroup PAC ID 7810800737, 171 clinicians

Practice addresses (Care Compare)

3878 Pershall Rd
Ferguson, MO 63135-1246
Phone (314) 738-2785

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
SSM Cardinal Glennon Childrens Hospital CurrentSince Apr 7, 2024 Accepting new patients
SSM Health Care St Louis CurrentSince Apr 7, 2024 Accepting new patients
SSM Health Care St. Louis CurrentSince Apr 7, 2024 Accepting new patients
SSM Cardinal Glennon Children's Hospital CurrentSince Apr 7, 2024 Accepting new patients

Locations

7344 Solutions Ctr
Chicago, IL 60677
Phone (314) 989-6189

1015 Bowles Ave
Fenton, MO 63026
Phone (636) 496-2000

13000 Butler Crest Dr
Saint Louis, MO 63128
Phone (314) 842-3535

1465 S Grand Blvd
Saint Louis, MO 63104
Phone (314) 268-4070

3878 Pershall Rd
Saint Louis, MO 63135
Phone (314) 344-6021

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1708041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708041600000",
    "number": "1326803511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1465 S GRAND BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631041003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1465 S GRAND BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631041003",
            "telephone_number": "314-577-5666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCLELLAN",
        "first_name": "ALYSSA",
        "credential": "CPNP-PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-16",
        "last_updated": "2024-02-16",
        "certification_date": "2024-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MO",
            "license": "2024006163",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.