Pravesh P Deotale, M.D

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

2015036367 Issued in MO

Practice address

1420 US Highway 61
Festus, MO 63028-4108

Phone

(636) 543-2230

NPI assigned

Jul 19, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Specialty

Psychiatry

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mercy Hospital PerryGroup PAC ID 1153777826, 115 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: pravesh.deotale.1@18773.direct.athenahealth.com

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.

• Mercy Hospital Perry

  • Critical Access Hospital
  • Perryville, MO
  • NPI 1063117158
  Medicare reassignment Care Compare group NPD
• Mercy Clinic Adult Hospitalists - St. Louis, LLC

  • Internal Medicine Physician
  • Saint Louis, MO
  • NPI 1841235108
  Medicare reassignment NPD
• Mercy Clinic Adult Hospitalists - Washington, LLC

  • Hospitalist Physician
  • Washington, MO
  • NPI 1891943429
  Medicare reassignment NPD
• Mercy Clinic Adult Hospitalists- Jefferson, LLC

  • Internal Medicine Physician
  • Festus, MO
  • NPI 1083052492
  Medicare reassignment NPD
• Mercy Clinic Adult Psychiatry, LLC

  • Psychiatry Physician
  • Festus, MO
  • NPI 1750788972
  Medicare reassignment NPD
• Mercy Clinic Child and Adolescent Psychiatry, LLC

  • Child & Adolescent Psychiatry Physician
  • Saint Louis, MO
  • NPI 1265562300
  Medicare reassignment NPD
• Mercy East Support Services, LLC

  • Internal Medicine Physician
  • Saint Louis, MO
  • NPI 1225382013
  Medicare reassignment NPD
• St Anthonys Physician Organization Hospitalist Services, L.C.

  dba Mercy Clinic South Hospitalists

  • Hospitalist Physician
  • Saint Louis, MO
  • NPI 1407216336
  Medicare reassignment NPD
• Mercy Hospital Perry

  dba Mercy Hospital Perry - RHC I

  • Rural Health Clinic/Center
  • Perryville, MO
  • NPI 1639858855
  NPD
• Monte Nido Missouri, LLC

  dba Clementine St. Louis

  • Mental Illness Community Based Residential Treatment Facility
  • Saint Louis, MO
  • NPI 1770227407
  NPD (past)

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

{
    "created_epoch": "1311033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745452800000",
    "number": "1710275110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 HIGH ACRES DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631324210",
            "telephone_number": "217-414-5131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1420 US HIGHWAY 61",
            "city": "FESTUS",
            "state": "MO",
            "postal_code": "630284108",
            "telephone_number": "636-543-2230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEOTALE",
        "first_name": "PRAVESH",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-19",
        "last_updated": "2025-04-24",
        "certification_date": "2025-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "IL",
            "license": "036135582",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "MO",
            "license": "2015036367",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Candace-Rae Diana Davis, DNP, RN, CPNP-PC
• Talina Dearing
• Kristine Decollo, MSPT
• Peggy E Degroot
• Suzanne Delaney Rapisardo
• Dependacare Medical Equipment Inc.
• Amy Lee Dickemper
• Ashlee Dickens, FNP-C
• Todd Marcus Dickneite, PT
• Jennifer Ann Diebold, AU.D.

• Child & Adolescent Psychiatry Physician in Festus, MO
• Providers in Festus, MO by specialty
• Child & Adolescent Psychiatry Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.