NPIMap

Organization Active NPI

Mercy Clinic ENT LLC

  • Otolaryngology Physician
  • Washington, MO
National Provider Identifier
1366705998
Registry record updated Apr 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
MERCY CLINIC ENT LLC
Practice address
901 Patients First Dr
Washington, MO 63090-4700
Phone
(636) 390-1570
Fax
(636) 390-1571
NPI assigned
Jun 19, 2012
Organization subpart
Yes
Parent organization
MERCY CLINIC EAST COMMUNITIESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 28, 2025

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

Authorized official

Name
Kerry Dunger
Title
Executive Director - License
Phone
(314) 364-3707

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Y00000X Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

901 Patients First Dr
Washington, MO 63090-4700

Mailing address

901 Patients First Dr
Washington, MO 63090-4700
Phone (636) 390-1570

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121114000539 MO Part B Supplier - Clinic/Group Practice 7517118813 Receives reassigned benefits from 21 practitioners
Practice locations: Ballwin, MO; Saint Louis, MO; Washington, MO

National Provider Directory

National Provider Directory
Part of
St John'S Mercy Medical Group

Locations

15945 Clayton Rd
Ste 360
Ballwin, MO 63011

607 S New Ballas Rd
Ste 2300
Saint Louis, MO 63141
Phone (314) 251-6394

901 Patients First Dr
#3500
Washington, MO 63090
Phone (636) 390-1570

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1340064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745798400000",
    "number": "1366705998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 PATIENTS FIRST DR",
            "city": "WASHINGTON",
            "state": "MO",
            "postal_code": "630904700",
            "telephone_number": "636-390-1570",
            "fax_number": "636-390-1571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 PATIENTS FIRST DR",
            "city": "WASHINGTON",
            "state": "MO",
            "postal_code": "630904700",
            "telephone_number": "636-390-1570",
            "fax_number": "636-390-1571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY CLINIC ENT LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MERCY CLINIC EAST COMMUNITIES",
        "enumeration_date": "2012-06-19",
        "last_updated": "2025-04-28",
        "certification_date": "2025-04-28",
        "status": "A",
        "authorized_official_last_name": "DUNGER",
        "authorized_official_first_name": "KERRY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR - LICENSE",
        "authorized_official_telephone_number": "314-364-3707"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.