Individual provider Active NPI

Julie R Ferguson, D.O

  • Pediatrics Physician
  • Saint Louis, MO
National Provider Identifier
1689602781
Registry record updated Apr 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
2006007043 Issued in MO
Practice address
1465 S. Grand Blvd
St. Louis, MO 63104
Phone
(314) 577-5360
Fax
(314) 268-4116
NPI assigned
Jun 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 2006007043 MO Primary
Pediatric Emergency Medicine (Emergency Medicine) Physician 207PP0204X 2006007043 MO

Addresses

Primary practice location

1465 S. Grand Blvd
St. Louis, MO 63104

Mailing address

3691 Rutger Ave
Provider Enrollment
St. Louis, MO 63110
Phone (314) 977-6828

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
I20070216000629 MO Practitioner - Pediatric Medicine 9739281056 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
2006007043MOMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
SSM Cardinal Glennon Childrens Hospital Pediatrics CurrentSince Jan 1, 2016 Accepting new patients
SSM Health Care St Louis CurrentSince Jan 1, 2016 Accepting new patients
SSM Cardinal Glennon Children's Hospital Pediatrics CurrentSince Jan 1, 2016 Accepting new patients
SSM Health Care St. Louis Pediatrics Past Accepting new patients

Locations

7344 Solutions Ctr
Chicago, IL 60677
Phone (314) 989-6189

1296 Jeffco Blvd
Arnold, MO 63010
Phone (636) 321-8600

1015 Bowles Ave
Fenton, MO 63026
Phone (636) 496-2000

2963 Doddridge Ave
Maryland Hts, MO 63043
Phone (314) 291-3909

1465 S Grand Blvd
Saint Louis, MO 63104
Phone (314) 268-4070

Interoperability endpoints

  • Direct secure messaging: jferguson11455@direct-ehr-ssmhc.com

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714089600000",
    "number": "1689602781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3691 RUTGER AVE",
            "address_2": "PROVIDER ENROLLMENT",
            "city": "ST. LOUIS",
            "state": "MO",
            "postal_code": "63110",
            "telephone_number": "314-977-6828",
            "fax_number": "317-977-6777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1465 S. GRAND BLVD",
            "city": "ST. LOUIS",
            "state": "MO",
            "postal_code": "63104",
            "telephone_number": "314-577-5360",
            "fax_number": "314-268-4116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERGUSON",
        "first_name": "JULIE",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-28",
        "last_updated": "2024-04-26",
        "certification_date": "2024-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2006007043",
            "primary": true
        },
        {
            "code": "207PP0204X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Pediatric Emergency Medicine",
            "state": "MO",
            "license": "2006007043",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.