Charles Phelan

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

2024049964 Issued in MO

Practice address

615 S New Ballas Rd
Creve Coeur, MO 63141-8221

Phone

(314) 251-6000

NPI assigned

Nov 7, 2024

Last updated

Dec 27, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Mercy Clinic Adult Hospitalists - St. Louis, LLC

  • Internal Medicine Physician
  • Saint Louis, MO
  • NPI 1841235108
  Medicare reassignment NPD
• St Anthonys Physician Organization Hospitalist Services, L.C.

  dba Mercy Clinic South Hospitalists

  • Hospitalist Physician
  • Saint Louis, MO
  • NPI 1407216336
  Medicare reassignment NPD

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

{
    "created_epoch": "1730937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735257600000",
    "number": "1467275487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 S NEW BALLAS RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418221",
            "telephone_number": "844-735-4710",
            "fax_number": "636-237-4074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 S NEW BALLAS RD",
            "city": "CREVE COEUR",
            "state": "MO",
            "postal_code": "631418221",
            "telephone_number": "314-251-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHELAN",
        "first_name": "CHARLES",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-11-07",
        "last_updated": "2024-12-27",
        "certification_date": "2024-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MO",
            "license": "2024049964",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MO",
            "license": "2015045012",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy L Pelligreen, CRNA
• Daniel Pernoud, DDS
• Linda Susan Pevnick, MSW
• Melinda Louise Pfeiffer
• Pui-Yue Phan III
• Serin Phruttitum, MD
• Physician Groups LC (Barnes West Medical Consultants)
• Physician Groups LC (Associated Internist)
• Jay F Piccirillo, MD
• Melissa Ann Piechocinski, FNP-BC

• Acute Care Nurse Practitioner in Creve Coeur, MO
• Providers in Creve Coeur, MO by specialty
• Acute Care Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.