Individual provider Active NPI

Jamison Ebert, AGNP

  • Nurse Practitioner
  • Saint Louis, MO
National Provider Identifier
1447619465
Registry record updated Sep 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
2018006932 Issued in MO
Practice address
625 S New Ballas Rd Ste 7063
Saint Louis, MO 63141-8218
Phone
(314) 251-4200
NPI assigned
Feb 18, 2016
Last updated
Sep 20, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse First Assistant 163WR0006X 2003018725 MO
Nurse Practitioner 363L00000X 2018006932 MO Primary

Addresses

Primary practice location

625 S New Ballas Rd Ste 7063
Saint Louis, MO 63141-8218

Mailing address

625 S New Ballas Rd Ste 7063
Saint Louis, MO 63141-8218
Phone (314) 251-4200

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address jebert12685@direct-ehr-ssmhc.com Direct
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other

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
I20180626001280 MO Practitioner - Nurse Practitioner 8426303850 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinic Surgical Specialists LLCGroup PAC ID 1153455076, 180 clinicians

Practice addresses (Care Compare)

625 S New Ballas Rd
Suite 7063
Saint Louis, MO 63141-8218
Phone (314) 251-4200

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2003018725MOMDRegistered Nurse First Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Surgical Specialists, LLC CurrentSince Sep 26, 2022 Accepting new patients
SSM Depaul Medical Group, Inc. PastSince Oct 1, 2020 Accepting new patients
Mercy Clinic East Communities PastSince Sep 25, 2022 Accepting new patients

Locations

621 S New Ballas Rd
Ste 3005B
Saint Louis, MO 63141
Phone (314) 251-7070

625 S New Ballas Rd
Ste 7063
Saint Louis, MO 63141
Phone (314) 251-1642

851 E 5th St
Ste 108
Washington, MO 63090
Phone (636) 239-4144

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1455753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663632000000",
    "number": "1447619465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 S NEW BALLAS RD STE 7063",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418218",
            "telephone_number": "314-251-4200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 S NEW BALLAS RD STE 7063",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418218",
            "telephone_number": "314-251-4200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EBERT",
        "first_name": "JAMISON",
        "credential": "AGNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-02-18",
        "last_updated": "2022-09-20",
        "certification_date": "2022-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WR0006X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Registered Nurse First Assistant",
            "state": "MO",
            "license": "2003018725",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MO",
            "license": "2018006932",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jebert12685@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "jebert12685@direct-ehr-ssmhc.com",
            "address_1": "12255 De Paul Dr Ste 205",
            "city": "Bridgeton",
            "state": "MO",
            "country_code": "US",
            "postal_code": "630442510",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "12255 De Paul Dr Ste 205",
            "city": "Bridgeton",
            "state": "MO",
            "country_code": "US",
            "postal_code": "630442510",
            "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.