Individual provider Active NPI

Katherine Bleisch

  • Adult Health Nurse Practitioner
  • Saint Louis, MO
National Provider Identifier
1477910719
Registry record updated Jan 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
2016000966 Issued in MO
Practice address
621 S New Ballas Rd
Saint Louis, MO 63141-8232
Phone
(314) 315-1494
NPI assigned
Jan 18, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 2016000966 MO Primary
Gerontology Nurse Practitioner 363LG0600X 2016000966 MO

Addresses

Primary practice location

621 S New Ballas Rd
Saint Louis, MO 63141-8232

Mailing address

2330 Eagle Pines Dr
Saint Charles, MO 63303-8321
Phone (314) 315-1494

Other identifiers 1

IdentifierTypeStateIssuer
46-2913068MedicaidMO

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
I20160314001658 MO Practitioner - Nurse Practitioner 9133425366 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinic Adult Hospitalists - St. Louis, LLCGroup PAC ID 6002809944, 139 clinicians

Practice addresses (Care Compare)

615 S New Ballas Rd
Saint Louis, MO 63141-8221
Phone (314) 251-6339

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2016000966MOMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Hospitals East Communities CurrentSince Feb 29, 2016 Accepting new patients
Mercy Hospitals East Communities CurrentSince Feb 29, 2016 Accepting new patients
Mercy Clinic Adult Hospitalists - St. Louis, LLC CurrentSince Feb 29, 2016 Accepting new patients

Locations

621 S New Ballas Rd
Ste 3016B
Saint Louis, MO 63141
Phone (314) 251-6339

615 S New Ballas Rd
#H
Saint Louis, MO 63141
Phone (314) 251-6075

621 S New Ballas Rd
Saint Louis, MO 63141
Phone (314) 432-0099

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

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": "1453075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453075200000",
    "number": "1477910719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2330 EAGLE PINES DR",
            "city": "SAINT CHARLES",
            "state": "MO",
            "postal_code": "633038321",
            "telephone_number": "314-315-1494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 S NEW BALLAS RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418232",
            "telephone_number": "314-315-1494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLEISCH",
        "first_name": "KATHERINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-18",
        "last_updated": "2016-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MO",
            "license": "2016000966",
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MO",
            "license": "2016000966",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "46-2913068",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.