Individual provider Active NPI

Lloyd John Vasquez III, NP-C

  • Adult Health Nurse Practitioner
  • Saint Louis, MO
National Provider Identifier
1710405188
Registry record updated Sep 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
2017025923 Issued in MO
Practice address
3635 Vista Ave
Saint Louis, MO 63110-2539
Phone
(314) 577-8338
NPI assigned
Sep 6, 2017
Last updated
Sep 6, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 2017025923 MO Primary

Addresses

Primary practice location

3635 Vista Ave
Saint Louis, MO 63110-2539

Mailing address

3635 Vista Ave
Saint Louis, MO 63110-2539
Phone (314) 577-8338

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
I20240627000150 MO Practitioner - Nurse Practitioner 1658815006 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cardiothoracic Surgery, LLCGroup PAC ID 1254365281, 14 clinicians

Practice addresses (Care Compare)

222 S Woods Mill Rd
Suite 550N
Chesterfield, MO 63017-3641
Phone (314) 434-3049

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2017025923MOMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Cardiothoracic Surgery, LLC CurrentSince Jun 30, 2024 Accepting new patients

Locations

222 S Woods Mill Rd
Ste 550
Chesterfield, MO 63017
Phone (314) 434-3049

222 S Woods Mill Rd
Ste 550N
Chesterfield, MO 63017
Phone (314) 434-3049

226 S Woods Mill Rd
Ste 550
Chesterfield, MO 63017

Organizations & group practices 1

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1504656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1504656000000",
    "number": "1710405188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3635 VISTA AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631102539",
            "telephone_number": "314-577-8338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3635 VISTA AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631102539",
            "telephone_number": "314-577-8338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VASQUEZ",
        "first_name": "LLOYD",
        "middle_name": "JOHN",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-09-06",
        "last_updated": "2017-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MO",
            "license": "2017025923",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.