Individual provider Active NPI

Teresa T Dillard, PNP

  • Nurse Practitioner
  • Saint Louis, MO
National Provider Identifier
1689830168
Registry record updated Apr 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
124737 Issued in MO
Practice address
3844 S Lindbergh Blvd
Ste 216
Saint Louis, MO 63127-1416
Phone
(314) 525-0580
Fax
(314) 525-0581
NPI assigned
Aug 4, 2008
Last updated
Apr 17, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 124737 MO Primary

Addresses

Primary practice location

3844 S Lindbergh Blvd
Ste 216
Saint Louis, MO 63127-1416

Mailing address

PO Box 7412049
Chicago, IL 60674-2049
Phone (314) 525-0580

Other identifiers 1

IdentifierTypeStateIssuer
429048309MedicaidMO

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
I20170210001827 MO Practitioner - Nurse Practitioner 7012290398 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
124737MOMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Arch Pediatrics LLC CurrentSince Nov 1, 2018 Accepting new patients
Mercy Clinic East Communities CurrentSince Apr 3, 2017 Accepting new patients
Mercy Hospitals East Communities CurrentSince Feb 6, 2017 Accepting new patients
Mercy Hospitals East Communities CurrentSince Feb 6, 2017 Accepting new patients

Locations

3844 S Lindbergh Blvd
Ste 216
Saint Louis, MO 63127
Phone (314) 525-0580

615 S New Ballas Rd
Saint Louis, MO 63141
Phone (314) 251-4687

621 S New Ballas Rd
Ste 4017B
Saint Louis, MO 63141
Phone (314) 872-9192

Interoperability endpoints

  • Direct secure messaging: tdillard100161@directc.mercy.net

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, 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": "1217808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744848000000",
    "number": "1689830168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7412049",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606742049",
            "telephone_number": "314-525-0580",
            "fax_number": "314-525-0581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3844 S LINDBERGH BLVD",
            "address_2": "STE 216",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631271416",
            "telephone_number": "314-525-0580",
            "fax_number": "314-525-0581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DILLARD",
        "first_name": "TERESA",
        "middle_name": "T",
        "name_prefix": "Mrs.",
        "credential": "PNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-04",
        "last_updated": "2025-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MO",
            "license": "124737",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "429048309",
            "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": "3844 S Lindbergh Blvd",
            "address_2": "Ste 216",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631271416",
            "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.