Individual provider Active NPI

Kyle Lester Ogle, AGNP

  • Gerontology Nurse Practitioner
  • Saint Louis, MO
National Provider Identifier
1629627625
Registry record updated Apr 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
2019028557 Issued in MO
Practice address
12634 Olive Blvd
Dept Neurological Surgery
Saint Louis, MO 63141-6337
Phone
(314) 362-3577
Fax
(314) 884-6004
NPI assigned
Sep 11, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 2019028557 MO Primary

Addresses

Primary practice location

12634 Olive Blvd
Dept Neurological Surgery
Saint Louis, MO 63141-6337

Mailing address

PO Box 7412011
Chicago, IL 60674-2011
Phone (314) 362-3577

Other identifiers 1

IdentifierTypeStateIssuer
420078797MedicaidMO

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Washington University

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
I20200504002496 MO Practitioner - Nurse Practitioner 5597097121 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
84.2 of 100Reported as group
Quality
71.6
Promoting interoperability
100
Improvement activities
40
Cost
75.75

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Washington University CurrentSince Mar 1, 2020 Accepting new patients
Washington University Past Accepting new patients

Locations

1 Barnes Jewish Hospital Plz
Saint Louis, MO 63110
Phone (314) 362-1700

4455 Duncan Ave
Saint Louis, MO 63110
Phone (314) 658-3800

1600 S Brentwood Blvd
Ste 600
Saint Louis, MO 63144
Phone (314) 362-4342

4921 Parkview Pl
Ste 6B6C
Saint Louis, MO 63110

3015 N Ballas Rd
Saint Louis, MO 63131
Phone (314) 996-5330

660 S Euclid Ave
Saint Louis, MO 63110

660 S Euclid Ave
#8111
Saint Louis, MO 63110
Phone (314) 362-3281

12634 Olive Blvd
Saint Louis, MO 63141
Phone (314) 434-0600

1044 N Mason Rd
Ste 110
Saint Louis, MO 63141

660 S Euclid Ave
#8057
Saint Louis, MO 63110
Phone (314) 747-2053

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1568160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744848000000",
    "number": "1629627625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7412011",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606742011",
            "telephone_number": "314-362-3577",
            "fax_number": "314-884-6004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12634 OLIVE BLVD",
            "address_2": "DEPT NEUROLOGICAL SURGERY",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631416337",
            "telephone_number": "314-362-3577",
            "fax_number": "314-884-6004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OGLE",
        "first_name": "KYLE",
        "middle_name": "LESTER",
        "name_prefix": "Mr.",
        "credential": "AGNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-09-11",
        "last_updated": "2025-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MO",
            "license": "2019028557",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "420078797",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "12634 Olive Blvd",
            "address_2": "Dept Neurological Surgery",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631416337",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.