Individual provider Active NPI

Jayne Marie Mangi, WHNP

  • Women's Health Nurse Practitioner
  • Saint Louis, MO
National Provider Identifier
1396409983
Registry record updated Apr 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Women's Health Nurse PractitionerTaxonomy code 363LW0102X
License
2021040984 Issued in MO
Practice address
4901 Forest Park Ave
Dept OBGYN, Ste 341
Saint Louis, MO 63108-1495
Phone
(314) 454-7882
Fax
(314) 454-5167
NPI assigned
Oct 28, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Women's Health Nurse Practitioner 363LW0102X 2021040984 MO Primary

Addresses

Primary practice location

4901 Forest Park Ave
Dept OBGYN, Ste 341
Saint Louis, MO 63108-1495

Mailing address

PO Box 60352
Saint Louis, MO 63160-0352
Phone (314) 454-7882

Other identifiers 1

IdentifierTypeStateIssuer
420106501MedicaidMO

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Washington University

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
I20220215002386 MO Order and Referring Only - Nurse Practitioner 9234522293

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
84.2 of 100Reported as group
Quality
71.6
Promoting interoperability
100
Improvement activities
40
Cost
75.75

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1635379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714003200000",
    "number": "1396409983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60352",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631600352",
            "telephone_number": "314-454-7882",
            "fax_number": "314-454-5167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4901 FOREST PARK AVE",
            "address_2": "DEPT OBGYN, STE 341",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631081495",
            "telephone_number": "314-454-7882",
            "fax_number": "314-454-5167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGI",
        "first_name": "JAYNE",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "WHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-28",
        "last_updated": "2024-04-25",
        "certification_date": "2021-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "MO",
            "license": "2021040984",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "420106501",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "4901 Forest Park Ave",
            "address_2": "Dept OBGYN, Ste 341",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631081495",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.