Individual provider Active NPI

Marissa Leigh Smith, FNP

  • Family Nurse Practitioner
  • Saint Louis, MO
National Provider Identifier
1720480015
Registry record updated Nov 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
2021009802 Issued in MO
Practice address
1600 S Brentwood Blvd
Div Neurology Sleep Med, Ste 600
Saint Louis, MO 63144-1320
Phone
(314) 362-1408
Fax
(314) 747-4342
NPI assigned
Sep 18, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 2021009802 MO Primary

Addresses

Primary practice location

1600 S Brentwood Blvd
Div Neurology Sleep Med, Ste 600
Saint Louis, MO 63144-1320

Mailing address

660 S Euclid Ave
CB 8111
Saint Louis, MO 63110-1010
Phone (314) 362-4342

Other identifiers 1

IdentifierTypeStateIssuer
420097107MedicaidMO

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 IL
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
I20231218000910 IL Practitioner - Nurse Practitioner 9638491590 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1 Saint Elizabeth Blvd
O Fallon, IL 62269-1099
Phone (618) 234-2120

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
96.63
Improvement activities
40
Cost
81.81

Merit-based Incentive Payment System (MIPS)

Final score
84.2 of 100Reported as group
Quality
71.6
Promoting interoperability
100
Improvement activities
40
Cost
75.75

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America-Illinois Hospitalists, LLP Current Accepting new patients
Cep America-Illinois Hospitalists CurrentSince Nov 7, 2023 Accepting new patients
Cep America-Illinois Hospitalists, LLP CurrentSince Nov 7, 2023 Accepting new patients

Locations

2100 Powell St
Ste 400
Emeryville, CA 94608
Phone (510) 350-2638

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

1 Saint Elizabeth Blvd
O Fallon, IL 62269
Phone 618234212012438

4500 Memorial Dr
Swansea, IL 62226
Phone (618) 233-7750

Organizations & group practices 3

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.

Hospital & facility affiliations 4

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": "1410998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636934400000",
    "number": "1720480015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "660 S EUCLID AVE",
            "address_2": "CB 8111",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101010",
            "telephone_number": "314-362-4342",
            "fax_number": "314-747-3813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 S BRENTWOOD BLVD",
            "address_2": "DIV NEUROLOGY SLEEP MED, STE 600",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631441320",
            "telephone_number": "314-362-1408",
            "fax_number": "314-747-4342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "MARISSA",
        "middle_name": "LEIGH",
        "name_prefix": "Ms.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-18",
        "last_updated": "2021-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2021009802",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "420097107",
            "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": "1600 S Brentwood Blvd",
            "address_2": "Div Neurology Sleep Med, Ste 600",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631441320",
            "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.