Individual provider Active NPI

Christina Lynn Roeder, FNP-C

  • Family Nurse Practitioner
  • Fenton, MO
National Provider Identifier
1619441201
Registry record updated Jan 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
2018041082 Issued in MO
Practice address
714 Gravois Rd
Fenton, MO 63026-7723
Phone
(636) 326-6100
NPI assigned
Jan 16, 2019
Last updated
Jan 16, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 2018041082 MO Primary

Addresses

Primary practice location

714 Gravois Rd
Fenton, MO 63026-7723

Mailing address

714 Gravois Rd
Fenton, MO 63026-7723

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
I20190207002014 MO Practitioner - Nurse Practitioner 7416295910 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mercy Clinic East CommunitiesGroup PAC ID 7214827922, 573 clinicians

Practice addresses (Care Compare)

1717 Catlin Dr
Barnhart, MO 63012-1216
Phone (636) 741-3233

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
2018041082MOMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic East Communities Family Current Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Feb 26, 2021 Accepting new patients
Mercy East Ambulatory Services LLC CurrentSince Nov 17, 2020 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Feb 26, 2021 Accepting new patients
Mercy Clinic East Communities CurrentSince May 10, 2024 Accepting new patients
Mercy Clinic East Communities CurrentSince May 10, 2024 Accepting new patients
Mercy Clinic Springfield Communities Family CurrentSince Feb 26, 2021 Accepting new patients

Locations

1717 Catlin Dr
Barnhart, MO 63012
Phone (636) 741-3233

15740 South Outer 40 Rd
Chesterfield, MO 63017
Phone (636) 735-4268

409 Lafayette Ctr
Manchester, MO 63011
Phone (636) 707-0764

1605 Martin Springs Dr
Rolla, MO 65401
Phone (573) 458-6379

1605 Martin Springs Dr
Ste 110
Rolla, MO 65401
Phone (573) 458-6300

621 S New Ballas Rd
Ste 189A
Saint Louis, MO 63141
Phone (314) 251-6335

2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905

901 Patients First Dr
Ste 1200
Washington, MO 63090
Phone (636) 390-1777

Organizations & group practices 7

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 4

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": "1547596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547596800000",
    "number": "1619441201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "714 GRAVOIS RD",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630267723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "714 GRAVOIS RD",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630267723",
            "telephone_number": "636-326-6100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROEDER",
        "first_name": "CHRISTINA",
        "middle_name": "LYNN",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-16",
        "last_updated": "2019-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2018041082",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fenton, MO

Sources for this page

Verify at the official NPI Registry.