NPIMap

Individual provider Active NPI

Allyson Leigh Roser, PA

  • Physician Assistant
  • Belleville, IL
National Provider Identifier
1639678451
Registry record updated Apr 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085.006541 Issued in IL
Practice address
4600 Memorial Dr Ste W3
Belleville, IL 62226-5359
Phone
(618) 222-8900
Fax
(618) 416-4449
NPI assigned
Feb 7, 2018
Last updated
Apr 7, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085.006541 IL Primary
Medical Physician Assistant 363AM0700X 1150728 MA

Addresses

Primary practice location

4600 Memorial Dr Ste W3
Belleville, IL 62226-5359

Mailing address

4600 Memorial Dr Ste W3
Belleville, IL 62226-5359
Phone (618) 222-8900

Other names 1

  • Allyson Leigh Peludat Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220830002581 MO Practitioner - Physician Assistant 1153667415 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SSM Health Care GroupGroup PAC ID 0143608372, 929 clinicians

Practice addresses (Care Compare)

10101 Woodfield LN
Saint Louis, MO 63132-2946
Phone (608) 280-4647

1011 Bowles Ave
Fenton, MO 63026-2387

1031 Bellevue Ave
Suite 280a
Saint Louis, MO 63117-1818
Phone (314) 977-7455

1201 S Grand Blvd
Saint Louis, MO 63104-1016
Phone (314) 617-2000

1225 S Grand Blvd
Saint Louis, MO 63104-1016

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.94 of 100Reported as group
Quality
68.52
Promoting interoperability
100
Improvement activities
40
Cost
72.22

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085.006541ILMDPhysician Assistant
1150728MAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
SSM Health Care Group CurrentSince Aug 1, 2022 Accepting new patients
SSM Health Care Group CurrentSince Aug 1, 2022 Accepting new patients
SSM Medical Group Inc. Past Accepting new patients

Locations

6800 State Route 162
Maryville, IL 62062
Phone (618) 288-4095

1011 Bowles Ave
Ste 400
Fenton, MO 63026
Phone (314) 821-4884

10101 Woodfield Ln
Saint Louis, MO 63132
Phone (608) 280-4647

1031 Bellevue Ave
Ste 280A
Saint Louis, MO 63117
Phone (314) 617-2110

1225 S Grand Blvd
#1L34
Saint Louis, MO 63104

1225 S Grand Blvd
Fl 1
Saint Louis, MO 63104
Phone (314) 257-3390

Interoperability endpoints

  • Direct secure messaging: aroser431214@direct-ehr-ssmhc.com

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 6

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": "1517961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617753600000",
    "number": "1639678451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4600 MEMORIAL DR STE W3",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622265359",
            "telephone_number": "618-222-8900",
            "fax_number": "618-416-4449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4600 MEMORIAL DR STE W3",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622265359",
            "telephone_number": "618-222-8900",
            "fax_number": "618-416-4449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSER",
        "first_name": "ALLYSON",
        "middle_name": "LEIGH",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-07",
        "last_updated": "2021-04-07",
        "certification_date": "2021-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.006541",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MA",
            "license": "1150728",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALLYSON",
            "last_name": "PELUDAT",
            "middle_name": "LEIGH",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Belleville, IL

Sources for this page

Verify at the official NPI Registry.