Individual provider Active NPI

Andrea Grace Brown, DO

  • Family Medicine Physician
  • Saint Louis, MO
National Provider Identifier
1548897499
Registry record updated Jun 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2022033110 Issued in MO
Practice address
3721 S Grand Blvd
Saint Louis, MO 63118-3405
Phone
(314) 328-0144
Fax
(314) 788-3021
NPI assigned
Mar 23, 2020
Last updated
Jun 27, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2022033110 MO Primary

Addresses

Primary practice location

3721 S Grand Blvd
Saint Louis, MO 63118-3405

Mailing address

3721 S Grand Blvd
Saint Louis, MO 63118-3405
Phone (314) 328-0144

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230530002968 MO Practitioner - Family Practice 4981020179 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dedicated Missouri Holding LLCGroup PAC ID 5395176820, 2 clinicians

Practice addresses (Care Compare)

175 N Oaks PLZ
Saint Louis, MO 63121-2925
Phone (305) 628-6117

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2022033110MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dedicated Missouri Holding, LLC CurrentSince Jul 1, 2023 Accepting new patients
Dedicated Missouri Holding, LLC CurrentSince Jul 1, 2023 Accepting new patients

Locations

1395 NW 167th St
Miami Gardens, FL 33169
Phone (305) 831-4760

175 N Oaks Plz
Saint Louis, MO 63121
Phone (314) 391-9777

3721 S Grand Blvd
Saint Louis, MO 63118
Phone (314) 328-0144

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 1

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": "1584921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687824000000",
    "number": "1548897499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3721 S GRAND BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631183405",
            "telephone_number": "314-328-0144",
            "fax_number": "314-788-3021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3721 S GRAND BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631183405",
            "telephone_number": "314-328-0144",
            "fax_number": "314-788-3021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "ANDREA",
        "middle_name": "GRACE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-23",
        "last_updated": "2023-06-27",
        "certification_date": "2023-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2022033110",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.