Individual provider Active NPI

Mindy Marie Faraone, FNP

  • Family Nurse Practitioner
  • Alton, IL
National Provider Identifier
1336619782
Registry record updated Sep 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209018555 Issued in IL
Practice address
4 Memorial Dr Ste 230B
Alton, IL 62002-6705
Phone
(636) 344-2014
NPI assigned
Nov 28, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 2018035985 MO
Family Nurse Practitioner 363LF0000X 2018035985 MO
Nurse Practitioner 363L00000X 209018555 IL
Family Nurse Practitioner 363LF0000X 209018555 IL Primary

Addresses

Primary practice location

4 Memorial Dr Ste 230B
Alton, IL 62002-6705

Mailing address

4 Memorial Dr Ste 230B
Alton, IL 62002-6705
Phone (636) 344-2014

Other practice location 1

20 Progress Point Pkwy Ste 206
O Fallon, MO 63368-2207
Phone (636) 344-2014

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, 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
I20190320001941 MO Practitioner - Nurse Practitioner 6608116124 Reassigns benefits to 1 organization
I20190401000354 IL Practitioner - Nurse Practitioner 6608116124 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fairview Heights Medical Group SCGroup PAC ID 6800784083, 448 clinicians

Practice addresses (Care Compare)

1 Memorial Dr
Alton, IL 62002-6722
Phone (618) 463-7240

11155 Dunn Rd
Suite 109N
Saint Louis, MO 63136-6148
Phone (314) 953-8799

Hospital & facility affiliations

  • Alton Memorial Hospital Hospital, Alton, IL, CCN 140002
  • Progress West Hospital Hospital, Ofallon, MO, CCN 260219
  • Barnes Jewish Hospital Hospital, Saint Louis, MO, CCN 260032

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209018555ILMDFamily Nurse Practitioner
2018035985MOMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Heights Medical Group SC CurrentSince Feb 11, 2019 Accepting new patients
Fairview Heights Medical Group SC CurrentSince Feb 11, 2019 Accepting new patients

Locations

1 Memorial Dr
Alton, IL 62002
Phone (618) 463-7240

4 Memorial Dr
Ste 230
Alton, IL 62002
Phone (618) 463-7874

4 Memorial Dr
Ste 230B
Alton, IL 62002
Phone (618) 463-7874

20 Progress Point Pkwy
Ste 206
O Fallon, MO 63368
Phone (636) 344-1073

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

660 Mason Ridge Center Dr
Saint Louis, MO 63141
Phone (314) 273-6433

11155 Dunn Rd
Ste 109N
Saint Louis, MO 63136
Phone (314) 837-3784

Organizations & group practices 2

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": "1543363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758844800000",
    "number": "1336619782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 MEMORIAL DR STE 230B",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620026705",
            "telephone_number": "636-344-2014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 MEMORIAL DR STE 230B",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620026705",
            "telephone_number": "636-344-2014"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20 Progress Point Pkwy Ste 206",
            "address_purpose": "LOCATION",
            "city": "O Fallon",
            "state": "MO",
            "postal_code": "633682207",
            "country_code": "US",
            "telephone_number": "636-344-2014",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FARAONE",
        "first_name": "MINDY",
        "middle_name": "MARIE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-28",
        "last_updated": "2025-09-26",
        "certification_date": "2025-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MO",
            "license": "2018035985",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2018035985",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209018555",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209018555",
            "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": "4 Memorial Dr Ste 230B",
            "city": "Alton",
            "state": "IL",
            "country_code": "US",
            "postal_code": "620026705",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Alton, IL

Sources for this page

Verify at the official NPI Registry.