Mercy Clinic Children'S Surgery, LLC
Organization Active NPI Pediatric Surgery Physician · St. Louis, MO
NPI 1649349804 · NPPES record last updated Apr 25, 2025
Key facts
- NPI
- 1649349804
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatric Surgery Physician 2086S0120X
- Legal business name
- MERCY CLINIC CHILDREN'S SURGERY, LLC
- Practice address
- 621 S. New Ballas Road
Suite 6018-B
St. Louis, MO 63141-8274 - Phone
- (314) 251-5940
- Fax
- (314) 251-5813
- NPI assigned
- Nov 6, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- MERCY CLINIC EAST COMMUNITIES
Authorized official
- Name
- Kerry Dunger
- Title
- Executive Director - Finance
- Phone
- (314) 364-3707
Parent organization (reported in NPPES) 1
Practitioners 109
-
Diana M Rice, PNP
-
James Branca, PNP
-
Charles E Coln, MD
-
Shaun Conley, D.O
-
David W. Irvine, MD
-
Kristen Seiler, M.D.
-
Deann Wilson, PNP-BC
-
Meghan Talley Glover, PA-C
-
Julie C Ail, OT
-
Lauren Michele Babb, MS, OTR/L
-
Alicia Marie Brinkman, CCC-SLP
-
Haley Logan Browning, MS, SLP
-
April Joy Church, DPT
-
Angelica Jayde Colarossi, OTR/L
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20191118000151 | MO | Part B Supplier - Clinic/Group Practice | 4385076199 |
Receives reassigned benefits from 12 practitioners Practice locations: Saint Louis, MO; O Fallon, MO |
National Provider Directory
- Part of
- St John'S Mercy Medical Group
Locations
12445 Dorsett Rd
Maryland Heights, MO 63043
Phone (314) 251-1820
621 S New Ballas Rd
Ste 6018
Saint Louis, MO 63141
300 Floyd Dr
Sikeston, MO 63801
Phone (573) 472-0397
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Surgery Physician |
2086S0120X | Yes |
Addresses
Primary practice location
621 S. New Ballas Road
Suite 6018-B
St. Louis, MO 63141-8274
Mailing address
621 S. New Ballas Road
Suite 6018-B
St. Louis, MO 63141-8274
Phone (314) 251-5940
Other names
- Mercy Children's Surgery Associates
Other providers in St. Louis, MO
- Mercy Clinic Children'S Heart Center, LLC
- Mercy Clinic Children'S Hospitalists - St. Louis, LLC
- Mercy Clinic Children'S Infectious Disease, LLC
- Mercy Clinic Children'S Palliative Care LLC
- Mercy Clinic Children'S Respiratory and Sleep Medicine, LLC
- Mercy Clinic Children'S Urology LLC
- Mercy Clinic East Communities
- Mercy Clinic East Communities
- Mercy Clinic East Communities
- Mercy Clinic East Communities
All providers in St. Louis, MO · Pediatric Surgery Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 25, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.