Individual provider Active NPI

Julie Ruth Rehagen, ANP

  • Adult Health Nurse Practitioner
  • Chesterfield, MO
National Provider Identifier
1487924411
Registry record updated Jan 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
2011037545 Issued in MO
Practice address
14805 N Outer 40 Rd
Suite 320
Chesterfield, MO 63017-6060
Phone
(888) 811-4677
NPI assigned
Jan 6, 2012
Last updated
Jan 6, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 2011037545 MO Primary

Addresses

Primary practice location

14805 N Outer 40 Rd
Suite 320
Chesterfield, MO 63017-6060

Mailing address

14805 N Outer 40 Rd
Suite 320
Chesterfield, MO 63017-6060
Phone (888) 811-4677

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, IL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20120309000361 MO Practitioner - Nurse Practitioner 2567621600 Reassigns benefits to 1 organization
I20120621000271 IL Practitioner - Nurse Practitioner 2567621600 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing

State licenses

LicenseStateTypeSpecialty
2011037545MOMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Specialized Wound Management LLC Adult Health CurrentSince Jan 3, 2012 Accepting new patients

Locations

200 Health Care Dr
#A
Greenville, IL 62246

1341 Walnut St
Murphysboro, IL 62966
Phone (618) 687-4665

14805 North Outer 40 Rd
Chesterfield, MO 63017
Phone (636) 536-0183

14805 North Outer 40 Rd
Ste 320
Chesterfield, MO 63017
Phone (636) 536-0183

1415 W White Oak St
Independence, MO 64050
Phone (816) 254-3500

809 E Gordon St
Marshall, MO 65340
Phone (660) 886-2247

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1325808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325808000000",
    "number": "1487924411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14805 N OUTER 40 RD",
            "address_2": "SUITE 320",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630176060",
            "telephone_number": "888-811-4677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14805 N OUTER 40 RD",
            "address_2": "SUITE 320",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630176060",
            "telephone_number": "888-811-4677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REHAGEN",
        "first_name": "JULIE",
        "middle_name": "RUTH",
        "name_prefix": "Miss",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-01-06",
        "last_updated": "2012-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MO",
            "license": "2011037545",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chesterfield, MO

Sources for this page

Verify at the official NPI Registry.