Individual provider Active NPI

Jessica L Sheehan, GNP

  • Gerontology Nurse Practitioner
  • Saint Louis, MO
National Provider Identifier
1467654772
Registry record updated Nov 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
209007047 Issued in IL
Practice address
12348 Old Tesson Rd Ste 240
Saint Louis, MO 63128-2251
Phone
(314) 467-3900
Fax
(314) 467-3919
NPI assigned
May 31, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 6, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 209007047 IL Primary
Nurse Practitioner 363L00000X 209007047 IL
Gerontology Registered Nurse 163WG0600X 209007047 IL
Primary Care Nurse Practitioner 363LP2300X 209007047 IL

Addresses

Primary practice location

12348 Old Tesson Rd Ste 240
Saint Louis, MO 63128-2251

Mailing address

PO Box 776084
Chicago, IL 60677-8586

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
I20230717001465 MO Practitioner - Nurse Practitioner 7315038890 Reassigns benefits to 2 organizations

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 East CommunitiesGroup PAC ID 7214827922, 573 clinicians

Practice addresses (Care Compare)

10010 Kennerly Rd
Saint Louis, MO 63128-2106
Phone (314) 525-1328

12348 Old Tesson Rd
Suite 240
Saint Louis, MO 63128-2251
Phone (314) 467-3900

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
209007047ILMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St Anthonys Physician Organization Hospitalist Services, L.C. CurrentSince Sep 29, 2024 Accepting new patients
Mercy Clinic East Communities CurrentSince Jul 17, 2023 Accepting new patients
Red Bud Clinic Corp Past Accepting new patients
DRS Pichet & Meechai Past Accepting new patients

Locations

12348 Old Tesson Rd
Ste 240
Saint Louis, MO 63128
Phone 3144673900 ext. 284

10010 Kennerly Rd
Saint Louis, MO 63128
Phone (314) 525-1328

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

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

Interoperability endpoints

  • Direct secure messaging: jessica_sheehan@yourcarecommunity.org

Organizations & group practices 4

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 3

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": "1180569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699228800000",
    "number": "1467654772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776084",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606778586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12348 OLD TESSON RD STE 240",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631282251",
            "telephone_number": "314-467-3900",
            "fax_number": "314-467-3919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEEHAN",
        "first_name": "JESSICA",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "GNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-31",
        "last_updated": "2023-11-06",
        "certification_date": "2023-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "IL",
            "license": "209007047",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209007047",
            "primary": false
        },
        {
            "code": "163WG0600X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Gerontology",
            "state": "IL",
            "license": "209007047",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "IL",
            "license": "209007047",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.