Individual provider Active NPI

Nichole Michele Lewis, PA

  • Physician Assistant
  • Saint Louis, MO
National Provider Identifier
1730357104
Registry record updated Apr 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2008003778 Issued in MO
Practice address
4921 Parkview PL
Div Im Gastroenterology, Ste 12B
Saint Louis, MO 63110-1032
Phone
(314) 747-2066
Fax
(314) 747-7111
NPI assigned
Feb 19, 2008
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
Physician Assistant 363A00000X 2008003778 MO Primary

Addresses

Primary practice location

4921 Parkview PL
Div Im Gastroenterology, Ste 12B
Saint Louis, MO 63110-1032

Mailing address

PO Box 7412011
Chicago, IL 60674-2011
Phone (314) 747-2066

Other identifiers 1

IdentifierTypeStateIssuer
220024466MedicaidMO

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, IL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20080414000617 MO Practitioner - Physician Assistant 2567549637 Reassigns benefits to 1 organization
I20170207000108 IL Practitioner - Physician Assistant 2567549637 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Washington UniversityGroup PAC ID 9830008770, 2,968 clinicians

Practice addresses (Care Compare)

1044 N Mason Rd
Suite 330
Saint Louis, MO 63141-6689
Phone (314) 362-3500

4921 Parkview PL
Saint Louis, MO 63110-1032

5201 Mid America PLZ
Saint Louis, MO 63129-0002

5225 Mid America PLZ
Saint Louis, MO 63129-0002
Phone (800) 647-2098

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
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Washington University CurrentSince Sep 1, 2021 Accepting new patients
SJL Health Systems Inc CurrentSince Aug 27, 2019 Accepting new patients
Washington University CurrentSince Sep 1, 2021 Accepting new patients
HSHS Medical Group Inc CurrentSince Aug 27, 2019 Accepting new patients
Washington University Past Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

1512 N Green Mount Rd
O Fallon, IL 62269
Phone (618) 624-0100

8 Millstone Campus Dr
Saint Louis, MO 63146
Phone (314) 273-4375

11525 Olde Cabin Rd
Saint Louis, MO 63141
Phone (314) 997-0554

1044 N Mason Rd
Ste 310
Saint Louis, MO 63141
Phone (314) 454-7177

660 S Euclid Ave
#8124
Saint Louis, MO 63110
Phone (314) 454-8201

1044 N Mason Rd
Ste 330
Saint Louis, MO 63141
Phone (314) 996-8103

4921 Parkview Pl
Ste 12B
Saint Louis, MO 63110
Phone (314) 747-9889

Organizations & group practices 7

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": "1203379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744848000000",
    "number": "1730357104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7412011",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606742011",
            "telephone_number": "314-747-2066",
            "fax_number": "314-747-7111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4921 PARKVIEW PL",
            "address_2": "DIV IM GASTROENTEROLOGY, STE 12B",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101032",
            "telephone_number": "314-747-2066",
            "fax_number": "314-747-7111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEWIS",
        "first_name": "NICHOLE",
        "middle_name": "MICHELE",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-19",
        "last_updated": "2025-04-17",
        "certification_date": "2021-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2008003778",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "220024466",
            "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": "4921 Parkview Pl",
            "address_2": "Div IM Gastroenterology, Ste 12B",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631101032",
            "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.