Individual provider Active NPI

Erica Renfrew Haste

  • Family Medicine Physician
  • Saint Louis, MO
National Provider Identifier
1689426272
Registry record updated Jun 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2024022530 Issued in MO
Practice address
12680 Olive Blvd BLDG Ste 300
Saint Louis, MO 63141-6289
Phone
(314) 251-8888
NPI assigned
Apr 4, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 15, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2024022530 MO Primary

Addresses

Primary practice location

12680 Olive Blvd BLDG Ste 300
Saint Louis, MO 63141-6289

Mailing address

12680 Olive Blvd BLDG Ste 300
Saint Louis, MO 63141-6289

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240718000630 MO Order and Referring Only - Family PracticePractitioner - Family Practice 6901342617

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2024022530MOMDFamily Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1712188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718409600000",
    "number": "1689426272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12680 OLIVE BLVD BLDG STE 300",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631416289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12680 OLIVE BLVD BLDG STE 300",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631416289",
            "telephone_number": "314-251-8888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HASTE",
        "first_name": "ERICA",
        "middle_name": "RENFREW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-04-04",
        "last_updated": "2024-06-15",
        "certification_date": "2024-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2024022530",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.