Individual provider Active NPI

Catherine Dolphin Smith, NP

  • Adult Health Nurse Practitioner
  • Ballwin, MO
National Provider Identifier
1336629641
Registry record updated Aug 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
2018024092 Issued in MO
Practice address
15945 Clayton Rd Ste 120B
Ballwin, MO 63011-2490
Phone
(636) 256-5070
Fax
(636) 256-5066
NPI assigned
Aug 16, 2018
Last updated
Aug 26, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 2018024092 MO Primary
Gerontology Nurse Practitioner 363LG0600X 2018024092 MO

Addresses

Primary practice location

15945 Clayton Rd Ste 120B
Ballwin, MO 63011-2490

Mailing address

15945 Clayton Rd Ste 120B
Ballwin, MO 63011-2490
Phone (636) 256-5070

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
I20230117001638 MO Practitioner - Nurse Practitioner 7416328133 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1997
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)

15945 Clayton Rd
Suite 340
Ballwin, MO 63011-2492
Phone (636) 256-5130

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic East Communities CurrentSince Jan 16, 2023 Accepting new patients
Mercy Hospitals East Communities Past Accepting new patients
Mercy Hospitals East Communities PastSince Sep 1, 2024 Accepting new patients

Locations

15945 Clayton Rd
Ste 120B
Ballwin, MO 63011
Phone (636) 256-5070

15945 Clayton Rd
Ste 340
Ballwin, MO 63011
Phone (636) 256-5130

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1534377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724630400000",
    "number": "1336629641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15945 CLAYTON RD STE 120B",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630112490",
            "telephone_number": "636-256-5070",
            "fax_number": "696-256-5066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15945 CLAYTON RD STE 120B",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630112490",
            "telephone_number": "636-256-5070",
            "fax_number": "636-256-5066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "CATHERINE",
        "middle_name": "DOLPHIN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-16",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MO",
            "license": "2018024092",
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MO",
            "license": "2018024092",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ballwin, MO

Sources for this page

Verify at the official NPI Registry.