Individual provider Active NPI

May Grace Villavicencio Fille, AGNP

  • Gerontology Nurse Practitioner
  • Saint Louis, MO
National Provider Identifier
1689406811
Registry record updated May 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
2023031635 Issued in MO
Practice address
10 Barnes West Dr
Div Im Hematology, Ste 200
Saint Louis, MO 63141-6287
Phone
(314) 362-7216
Fax
(314) 362-8813
NPI assigned
Aug 16, 2024
Last updated
May 1, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 1, 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 2023031635 MO Primary

Addresses

Primary practice location

10 Barnes West Dr
Div Im Hematology, Ste 200
Saint Louis, MO 63141-6287

Mailing address

PO Box 7412011
Chicago, IL 60674-2011
Phone (314) 362-7216

Other identifiers 1

IdentifierTypeStateIssuer
420156260MedicaidMO

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
I20250520002135 MO Practitioner - Nurse Practitioner 4284152562 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Washington UniversityGroup PAC ID 9830008770, 2,968 clinicians

Practice addresses (Care Compare)

10 Barnes W Dr
Suite 200
Saint Louis, MO 63141-6350
Phone (314) 996-3238

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Washington University CurrentSince Apr 16, 2025 Accepting new patients
Washington University CurrentSince Apr 16, 2025 Accepting new patients
Washington University Past Accepting new patients

Locations

10 Barnes West Dr
Ste 200
Saint Louis, MO 63141
Phone (314) 996-8670

1234 S Kingshighway Blvd
Ste 1100
Saint Louis, MO 63110

660 S Euclid Ave
Saint Louis, MO 63110

8 Millstone Campus Dr
Saint Louis, MO 63146
Phone (314) 273-4375

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.

NPI Registry JSON

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

{
    "created_epoch": "1723766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746057600000",
    "number": "1689406811",
    "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": "314-362-7216",
            "fax_number": "314-362-8813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 BARNES WEST DR",
            "address_2": "DIV IM HEMATOLOGY, STE 200",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631416287",
            "telephone_number": "314-362-7216",
            "fax_number": "314-362-8813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FILLE",
        "first_name": "MAY GRACE",
        "middle_name": "VILLAVICENCIO",
        "name_prefix": "Ms.",
        "credential": "AGNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-16",
        "last_updated": "2025-05-01",
        "certification_date": "2024-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MO",
            "license": "2023031635",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "420156260",
            "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": "10 Barnes West Dr",
            "address_2": "Div IM Hematology, Ste 200",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631416287",
            "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.