Andrea E Ivy, N.P.

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

137743 Issued in MO

Practice address

12800 Boenker LN
Bridgeton, MO 63044-2438

Phone

(314) 551-0338

Fax

(314) 551-0336

NPI assigned

May 12, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Specialty

Nurse Practitioner

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Py Medical Services of Mo PCGroup PAC ID 4284075904, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Py Medical Services of Mo PC

  • Internal Medicine Physician
  • Saint Louis, MO
  • NPI 1316799042
  Medicare reassignment Care Compare group NPD
• Altea Medical Missouri LLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Wildwood, MO
  • NPI 1649032608
  Medicare reassignment NPD
• Post Acute Medical PLLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Lanham, MD
  • NPI 1730713025

  MO

  Medicare reassignment NPD

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405296000000",
    "number": "1649220104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12800 BOENKER LN",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442438",
            "telephone_number": "314-551-0338",
            "fax_number": "314-551-0336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12800 BOENKER LN",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442438",
            "telephone_number": "314-551-0338",
            "fax_number": "314-551-0336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVY",
        "first_name": "ANDREA",
        "middle_name": "E",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-12",
        "last_updated": "2014-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "137743",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "429398209",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Impact Physician Group, Missouri Pulmonary Services LLC
• Impact Physician Group, Missouri, LLC
• In Good Hands CDS, LLC
• Infinite Health Services
• Interventional Pain Institute LLC
• Jacob Jackson, D.O.
• Warren Orlando Jackson, AGNP
• Asia Jacobs
• Vishal Prashant Jadhav, DPM
• Christopher D Jaeger, MD

• Family Nurse Practitioner in Bridgeton, MO
• Providers in Bridgeton, MO by specialty
• Family Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2014; 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.

Verify at the official NPI Registry.