Individual provider Active NPI

William Stephen Forness, FNP-C

  • Family Medicine Physician
  • Saint Louis, MO
National Provider Identifier
1386237097
Registry record updated Feb 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
F09191408 Issued in MO
Practice address
621 S New Ballas Rd Ste 560a
Saint Louis, MO 63141-8261
Phone
(314) 251-6440
Fax
(314) 251-4456
NPI assigned
Feb 12, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 12, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X F09191408 MO Primary

Addresses

Primary practice location

621 S New Ballas Rd Ste 560a
Saint Louis, MO 63141-8261

Mailing address

1343 Flintshire LN
Lake St Louis, MO 63367-1947
Phone (314) 517-1366

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
I20210325001096 MO Practitioner - Nurse Practitioner 3375950009 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinic Trauma and General Surgery LLCGroup PAC ID 1658320700, 44 clinicians

Practice addresses (Care Compare)

621 S New Ballas Rd
Suite 560a
Saint Louis, MO 63141-8261
Phone (314) 569-6440

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
F09191408MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Trauma and General Surgery, LLC Single Specialty CurrentSince Jul 29, 2022 Accepting new patients
Mercy Clinic Burn and Plastic Surgery, LLC Single Specialty CurrentSince Jan 14, 2024 Accepting new patients

Locations

621 S New Ballas Rd
Ste 560A
Saint Louis, MO 63141
Phone (314) 251-6440

701 S New Ballas Rd
Ste 310
Saint Louis, MO 63141
Phone (314) 251-8750

615 S New Ballas Rd
Saint Louis, MO 63141
Phone (314) 251-4687

901 E 5th St
Washington, MO 63090
Phone (636) 239-8000

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 2

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": "1613088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613088000000",
    "number": "1386237097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1343 FLINTSHIRE LN",
            "city": "LAKE ST LOUIS",
            "state": "MO",
            "postal_code": "633671947",
            "telephone_number": "314-517-1366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 S NEW BALLAS RD STE 560A",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418261",
            "telephone_number": "314-251-6440",
            "fax_number": "314-251-4456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORNESS",
        "first_name": "WILLIAM",
        "middle_name": "STEPHEN",
        "name_prefix": "Mr.",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-02-12",
        "last_updated": "2021-02-12",
        "certification_date": "2021-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "F09191408",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.