Individual provider Active NPI

Jay Patrick Nelson, MD

  • Diagnostic Radiology Physician
  • Saint Louis, MO
National Provider Identifier
1477085520
Registry record updated Mar 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
2022019192 Issued in MO
Practice address
615 S New Ballas Rd
Saint Louis, MO 63141-8221
Phone
(314) 251-6031
Fax
(314) 251-6343
NPI assigned
Mar 29, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2026

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 40628 OK
Diagnostic Radiology Physician 2085R0202X 111377 GA
Diagnostic Radiology Physician 2085R0202X 2022019192 MO Primary
Neuroradiology Physician 2085N0700X 0101288049 VA

Addresses

Primary practice location

615 S New Ballas Rd
Saint Louis, MO 63141-8221

Mailing address

11475 Olde Cabin Rd Ste 200
Saint Louis, MO 63141-7129
Phone (314) 991-8210

Other practice location 1

2300 Opitz Blvd
Woodbridge, VA 22191-3311
Phone (703) 523-0611

Other practice location 2

743 Spring St NE
Gainesville, GA 30501-3715
Phone (770) 219-9000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, SC, GA3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20220629001518 MO Practitioner - Diagnostic Radiology 3577943117 Reassigns benefits to 6 organizations
I20260226003501 SC Practitioner - Diagnostic Radiology 3577943117 Reassigns benefits to 1 organization
I20260512003452 GA Practitioner - Diagnostic Radiology 3577943117 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Missouri, Columbia School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
West County Radiological Group IncGroup PAC ID 8527966944, 105 clinicians
East Cooper Physician Group LLCGroup PAC ID 1254775687, shared by 2 NPIs, 126 clinicians

Practice addresses (Care Compare)

615 S New Ballas Rd
Saint Louis, MO 63141-8221
Phone (314) 251-6031

880 Island Park Dr
Unit 230
Daniel Island, SC 29492-2902
Phone (843) 380-9330

930 Wynhaven LN
Ballwin, MO 63011-2938
Phone (843) 881-0100

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.77 of 100Reported as group
Quality
86.95
Improvement activities
40
Cost
73.15

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
0101288049VAMDNeuroradiology Physician
111377GAMDDiagnostic Radiology Physician
2022019192MOMDDiagnostic Radiology Physician
40628OKMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Miracl, LLC CurrentSince Jul 1, 2022 Accepting new patients
West County Radiological Group, Inc. Neuroradiology CurrentSince Jul 1, 2023 Accepting new patients
Washington University Neuroradiology CurrentSince Jul 1, 2022 Accepting new patients
East Cooper Physician Group LLC CurrentSince Jan 17, 2026 Accepting new patients
East Cooper Physician Group LLC CurrentSince Jan 17, 2026 Accepting new patients

Locations

1400 US Highway 61
Crystal Cty, MO 63028
Phone (636) 933-1111

630 NW Englewood Rd
Kansas City, MO 64118
Phone (816) 453-2700

1000 W 10th St
Rolla, MO 65401
Phone (573) 364-9000

615 S New Ballas Rd
Saint Louis, MO 63141
Phone (314) 251-4687

510 S Kingshighway Blvd
Saint Louis, MO 63110
Phone (314) 362-0177

660 S Euclid Ave
#8131
Saint Louis, MO 63110
Phone (314) 362-2809

510 S Kingshighway Blvd
#8131
Saint Louis, MO 63110
Phone (314) 362-2900

11475 Olde Cabin Rd
Ste 200
Saint Louis, MO 63141
Phone (314) 991-8200

701 S New Ballas Rd
Saint Louis, MO 63141
Phone (314) 251-6710

1000 E Cherry St
Troy, MO 63379
Phone (636) 528-3327

901 E 5th St
Washington, MO 63090
Phone (636) 239-8000

880 Island Park Dr
Unit 230
Daniel Island, SC 29492
Phone (843) 380-9330

851 Leonard Fulghum Dr
Ste 101
Mt Pleasant, SC 29464
Phone (843) 884-2133

2000 Hospital Dr
Mt Pleasant, SC 29464
Phone (803) 533-2200

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.

Hospital & facility affiliations 6

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": "1490745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773705600000",
    "number": "1477085520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11475 OLDE CABIN RD STE 200",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631417129",
            "telephone_number": "314-991-8210",
            "fax_number": "314-991-8206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 S NEW BALLAS RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418221",
            "telephone_number": "314-251-6031",
            "fax_number": "314-251-6343"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2300 Opitz Blvd",
            "address_purpose": "LOCATION",
            "city": "Woodbridge",
            "state": "VA",
            "postal_code": "221913311",
            "country_code": "US",
            "telephone_number": "703-523-0611",
            "fax_number": "703-670-2089",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "743 Spring St NE",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "GA",
            "postal_code": "305013715",
            "country_code": "US",
            "telephone_number": "770-219-9000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NELSON",
        "first_name": "JAY",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-29",
        "last_updated": "2026-03-17",
        "certification_date": "2026-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OK",
            "license": "40628",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "GA",
            "license": "111377",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MO",
            "license": "2022019192",
            "primary": true
        },
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "VA",
            "license": "0101288049",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.