Individual provider Active NPI

Irene Marion Rathjen, PNP

  • Pediatric Nurse Practitioner
  • Saint Louis, MO
National Provider Identifier
1447629464
Registry record updated Apr 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
2015016091 Issued in MO
Practice address
1 Childrens PL
Div Ped Genetics and Genomic Med
Saint Louis, MO 63110-1002
Phone
(314) 454-6093
Fax
(844) 965-9624
NPI assigned
Sep 21, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 2015016091 MO Primary

Addresses

Primary practice location

1 Childrens PL
Div Ped Genetics and Genomic Med
Saint Louis, MO 63110-1002

Mailing address

PO Box 7412011
Chicago, IL 60674-2011
Phone (314) 454-6093

Other identifiers 1

IdentifierTypeStateIssuer
420033957MedicaidMO

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
I20160816001545 MO Practitioner - Nurse Practitioner 3678867553 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Washington UniversityGroup PAC ID 9830008770, 2,968 clinicians

Practice addresses (Care Compare)

1 Childrens PL
Saint Louis, MO 63110-1002
Phone (314) 273-1006

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Shriners Hospitals for Children CurrentSince Jun 5, 2020 Accepting new patients
Washington University CurrentSince Sep 12, 2023 Accepting new patients
Washington University CurrentSince Sep 12, 2023 Accepting new patients
Mercy Clinic East Communities CurrentSince Jun 27, 2016 Accepting new patients
Shriners Hospitals for Children CurrentSince Jun 5, 2020 Accepting new patients
Shriners Hospitals for Children Past Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

4400 Clayton Ave
Saint Louis, MO 63110
Phone (314) 432-3600

621 S New Ballas Rd
Ste 4017B
Saint Louis, MO 63141
Phone (314) 872-9192

1 Childrens Pl
Saint Louis, MO 63110
Phone (314) 454-2076

1 Childrens Pl
Ste C
Saint Louis, MO 63110
Phone (314) 454-2104

621 S New Ballas Rd
Ste 189A
Saint Louis, MO 63141
Phone (314) 251-6335

12348 Old Tesson Rd
Ste 160
Saint Louis, MO 63128
Phone (314) 251-6898

1 Childrens Pl
Fl 2
Saint Louis, MO 63110
Phone (314) 454-6120

12348 Old Tesson Rd
Ste 250
Saint Louis, MO 63128
Phone (314) 272-2727

Organizations & group practices 7

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": "1442793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744848000000",
    "number": "1447629464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7412011",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606742011",
            "telephone_number": "314-454-6093",
            "fax_number": "844-965-9624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 CHILDRENS PL",
            "address_2": "DIV PED GENETICS AND GENOMIC MED",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101002",
            "telephone_number": "314-454-6093",
            "fax_number": "844-965-9624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RATHJEN",
        "first_name": "IRENE",
        "middle_name": "MARION",
        "name_prefix": "Ms.",
        "credential": "PNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-21",
        "last_updated": "2025-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MO",
            "license": "2015016091",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "420033957",
            "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": "1 Childrens Pl",
            "address_2": "Div Ped Genetics and Genomic Med",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631101002",
            "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.