Individual provider Active NPI

Andrew T Pickens III, MD

  • Psychiatry Physician
  • St Louis, MO
National Provider Identifier
1366543746
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
32150 Issued in MO
Practice address
1034 S Brentwood Blvd
Suite 500
St Louis, MO 63117
Phone
(314) 727-2700
Fax
(314) 727-2773
NPI assigned
Sep 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 32150 MO Primary

Addresses

Primary practice location

1034 S Brentwood Blvd
Suite 500
St Louis, MO 63117

Mailing address

1034 S Brentwood Blvd
Suite 500
St Louis, MO 63117
Phone (314) 727-2700

Other identifiers 7

IdentifierTypeStateIssuer
A10290OtherMERCY HEALTH PLANS
57158OtherCMR
015011OtherEXCLUSIVE CHOICE
10742OtherMOBLUE CROSS BLUE SHIELD
102091OtherHEALTHLINK
154119OtherUNITED HEALTHCARE
154119OtherUNITED BEHAVIORAL HEALTH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
32150MOMDPsychiatry Physician

NPI Registry JSON

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1366543746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1034 S BRENTWOOD BLVD",
            "address_2": "SUITE 500",
            "city": "ST LOUIS",
            "state": "MO",
            "postal_code": "63117",
            "telephone_number": "314-727-2700",
            "fax_number": "314-727-2773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1034 S BRENTWOOD BLVD",
            "address_2": "SUITE 500",
            "city": "ST LOUIS",
            "state": "MO",
            "postal_code": "63117",
            "telephone_number": "314-727-2700",
            "fax_number": "314-727-2773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PICKENS",
        "first_name": "ANDREW",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MO",
            "license": "32150",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MERCY HEALTH PLANS",
            "identifier": "A10290",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CMR",
            "identifier": "57158",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EXCLUSIVE CHOICE",
            "identifier": "015011",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "10742",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "102091",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "154119",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED BEHAVIORAL HEALTH",
            "identifier": "154119",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.