Active NPI
Tatonya Monique Roberts, FNP
- Family Nurse Practitioner
- Ballwin, MO
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 2017004145
- Practice address
- 14400 Clayton Rd
Ballwin, MO 63011-2713 - Phone
- (636) 207-1137
- NPI assigned
- Apr 20, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 209015544 | IL | |
| Family Nurse Practitioner | 363LF0000X | 2017004145 | MO | Primary |
Addresses
Primary practice location
14400 Clayton Rd
Ballwin, MO 63011-2713
Mailing address
14400 Clayton Rd
Ballwin, MO 63011-2713
Phone (636) 207-1137
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| F1116320 | Other | IL | AANP CERTIFICATION |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL, MO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
11560 Olive Blvd
Creve Coeur, MO 63141-7111
Phone (866) 389-2727
14400 Clayton Rd
Ballwin, MO 63011-2713
Phone (866) 389-2727
15846 Manchester Rd
Ellisville, MO 63011-2208
Phone (866) 389-2727
3002 Hwy K
O Fallon, MO 63368-8675
Phone (866) 389-2727
3825 S Noland Rd
Independence, MO 64055-3344
Phone (866) 389-2727
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Minuteclinic Diagnostic of Kansas PA | Family | Current | Accepting new patients |
| SSM Health Care St Louis | Current | Accepting new patients | |
| SSM Health Care St. Louis | Current | Accepting new patients |
Locations
7344 Solutions Ctr
Chicago, IL 60677
Phone (314) 989-6189
14400 Clayton Rd
Ballwin, MO 63011
Phone (636) 207-1137
1015 Bowles Ave
Fenton, MO 63026
Phone (636) 496-2000
1120 Shackelford Rd
Florissant, MO 63031
Phone (314) 830-5805
3825 S Noland Rd
Independence, MO 64055
Phone (816) 254-6002
2022 Dorsett Vlg
Maryland Heights, MO 63043
Phone (314) 520-0520
8021 Watson Rd
Webster Groves, MO 63119
Phone (314) 963-0398
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 and National Provider Directory roles.
-
- Emergency Medicine Physician
- Fenton, MO
- NPI 1275586174
-
- Cardiovascular Disease Physician
- Bridgeton, MO
- NPI 1376598599
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1492646400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719273600000",
"number": "1639603293",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14400 CLAYTON RD",
"city": "BALLWIN",
"state": "MO",
"postal_code": "630112713",
"telephone_number": "636-207-1137"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14400 CLAYTON RD",
"city": "BALLWIN",
"state": "MO",
"postal_code": "630112713",
"telephone_number": "636-207-1137"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "TATONYA",
"middle_name": "MONIQUE",
"credential": "FNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-04-20",
"last_updated": "2024-06-25",
"certification_date": "2024-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "IL",
"license": "209015544",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MO",
"license": "2017004145",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AANP CERTIFICATION",
"identifier": "F1116320",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Ballwin, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.