Ardis K Allison, DO
Individual provider Active NPI Pediatrics Physician · O'Fallon, MO
NPI 1487609616 · NPPES record last updated Apr 22, 2009
Key facts
- NPI
- 1487609616
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- R3J00 (MO)
- Practice address
- 5551 Winghaven Blvd
Suite 240
O'Fallon, MO 63368-3605 - Phone
- (636) 561-5561
- Fax
- (636) 561-5557
- NPI assigned
- May 24, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051114000010 | MO | Practitioner - Pediatric Medicine | 0648299321 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R3J00 | MO | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| SSM Health Care St Louis | Current |
Accepting new patients | |
| Winghaven Pediatrics LLC | Pediatrics | Past | Accepting new patients |
Locations
7344 Solutions Ctr
Chicago, IL 60677
Phone (314) 989-6189
1015 Bowles Ave
Fenton, MO 63026
Phone (636) 496-2000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | R3J00 | MO | Yes |
Addresses
Primary practice location
5551 Winghaven Blvd
Suite 240
O'Fallon, MO 63368-3605
Mailing address
5551 Winghaven Blvd
Suite 240
O Fallon, MO 63368-3617
Phone (636) 561-5561
Other providers in O'Fallon, MO
- Alex Sharifian DDS Ofallon Modern Dentistry PC
- Bethany Arkills
- Alissa Ballard
- Bankhead Orthodontics DDS PC
- Aliece Nicole Barklage
- Tara Lynn Barnes-Cherry
All providers in O'Fallon, MO · Pediatrics Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 22, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.