Individual provider Active NPI

Amy L Salzer Bothmann, RN

  • Psychiatric/Mental Health Nurse Practitioner
  • Saint Louis, MO
National Provider Identifier
1376787192
Registry record updated Jan 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
2018038860 Issued in MO
Practice address
11102 Lindbergh Business CT
Saint Louis, MO 63123-7810
Phone
(314) 221-0491
NPI assigned
Apr 23, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 132329 MO
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 2018038860 MO Primary

Addresses

Primary practice location

11102 Lindbergh Business CT
Saint Louis, MO 63123-7810

Mailing address

3309 S Kingshighway Blvd
Saint Louis, MO 63139-1101
Phone (314) 206-3700

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
I20190508002071 MO Practitioner - Nurse Practitioner 3870835010 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Missouri St Louis - School of Optometry, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
BJC Behavioral HealthGroup PAC ID 1153225271, shared by 2 NPIs, 63 clinicians

Practice addresses (Care Compare)

3309 S Kingshighway Blvd
Saint Louis, MO 63139-1101
Phone (314) 206-3700

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
132329MOMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
BJC Behavioral Health CurrentSince Mar 31, 2019 Accepting new patients
BJC Behavioral Health CurrentSince Mar 31, 2019 Accepting new patients

Locations

1085 Maple St
Farmington, MO 63640
Phone (573) 756-5353

1430 Olive St
Ste 400
Saint Louis, MO 63103

11102 Lindbergh Ct
Saint Louis, MO 63123
Phone (314) 206-3400

3309 S Kingshighway Blvd
Saint Louis, MO 63139
Phone (314) 534-9350

Interoperability endpoints

  • FHIR API: https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

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.

NPI Registry JSON

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

{
    "created_epoch": "1240444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705968000000",
    "number": "1376787192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3309 S KINGSHIGHWAY BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631391101",
            "telephone_number": "314-206-3700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11102 LINDBERGH BUSINESS CT",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631237810",
            "telephone_number": "314-221-0491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SALZER BOTHMANN",
        "first_name": "AMY",
        "middle_name": "L",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-23",
        "last_updated": "2024-01-23",
        "certification_date": "2024-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MO",
            "license": "132329",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MO",
            "license": "2018038860",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.