Briana Waldeck, N.P.

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

209011703 Issued in IL

Practice address

5213 Godfrey Rd Ste 110
Godfrey, IL 62035-2510

Phone

(618) 619-3330

Fax

(618) 619-3390

NPI assigned

Aug 19, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

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

Specialty

Nurse Practitioner

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Fairview Heights Medical Group SCGroup PAC ID 6800784083, 448 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

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.

• Fairview Heights Medical Group SC

  • Multi-Specialty Clinic/Center
  • Saint Louis, MO
  • NPI 1679503668

  IL

  Medicare reassignment Care Compare group NPD
• Fairview Heights Medical Group SC

  • Multi-Specialty Clinic/Center
  • Saint Louis, MO
  • NPI 1073022000
  NPD
• Edwardsville Physicians Group LLC

  • Surgery Physician
  • Edwardsville, IL
  • NPI 1376014175
  NPD (past)
• Lincoln Surgical Group

  • Surgery Physician
  • Belleville, IL
  • NPI 1700962271
  NPD (past)
• Christian Hospital Physician Billing Services LLC

  • Cardiovascular Disease Physician
  • Saint Louis, MO
  • NPI 1689828501
  NPD (past)

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

{
    "created_epoch": "1408406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717372800000",
    "number": "1477952067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 W LINCOLN ST",
            "address_2": "SUITE 500",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622201900",
            "telephone_number": "618-277-7400",
            "fax_number": "618-277-7422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5213 GODFREY RD STE 110",
            "city": "GODFREY",
            "state": "IL",
            "postal_code": "620352510",
            "telephone_number": "618-619-3330",
            "fax_number": "618-619-3390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALDECK",
        "first_name": "BRIANA",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-19",
        "last_updated": "2024-06-03",
        "certification_date": "2024-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209011703",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209011703",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "5213 Godfrey Rd Ste 110",
            "city": "Godfrey",
            "state": "IL",
            "country_code": "US",
            "postal_code": "620352510",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Katelyn Elizabeth Vallow
• Christina Varady, APRN
• Jon Anthony Wagnon, D.O.
• Christopher S Wagoner, MD
• Wal-Mart Stores Inc
• Walmart Inc.
• Maria Jean Waltz, LMT
• Nicole Lynn Warren
• Tamara Renee Watson
• Terri Watson

• Nurse Practitioner in Godfrey, IL
• Providers in Godfrey, IL by specialty
• Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.