Individual provider Active NPI

Maria Lena Walls, ANP

  • Adult Health Nurse Practitioner
  • Saint Louis, MO
National Provider Identifier
1740517515
Registry record updated Mar 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
2009034346 Issued in MO
Practice address
3009 N Ballas Rd Ste 359C
Saint Louis, MO 63131-2324
Phone
(314) 996-4545
Fax
(314) 996-4546
NPI assigned
Nov 15, 2009
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 29, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 2004018016 MO
Adult Health Nurse Practitioner 363LA2200X 2009034346 MO Primary

Addresses

Primary practice location

3009 N Ballas Rd Ste 359C
Saint Louis, MO 63131-2324

Mailing address

670 Mason Ridge Center Dr
Ste 300
Saint Louis, MO 63141-8573
Phone (314) 996-4545

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Health Information Exchange (HIE)

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
I20100320000256 MO Practitioner - Nurse Practitioner 9739214362 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Physician Groups LCGroup PAC ID 3072421254, 526 clinicians

Practice addresses (Care Compare)

1110 Highlands Plaza Dr E
Saint Louis, MO 63110-1351
Phone (314) 273-0195

2630 Hwy K
O Fallon, MO 63368-6624
Phone (636) 240-5454

3009 N Ballas Rd
Saint Louis, MO 63131-2324

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2004018016MOMDRegistered Nurse
2009034346MOMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Physician Groups LC CurrentSince Jul 21, 2014 Accepting new patients
Physician Groups LC CurrentSince Jul 21, 2014 Accepting new patients
SSM Depaul Medical Group, Inc. Past Accepting new patients

Locations

2630 Highway K
O Fallon, MO 63368
Phone (636) 240-5454

670 Mason Ridge Center Dr
Ste 300
Saint Louis, MO 63141
Phone (314) 953-8250

3009 N Ballas Rd
Ste 359C
Saint Louis, MO 63131
Phone (314) 996-3520

3009 N Ballas Rd
Ste 383C
Saint Louis, MO 63131
Phone (314) 305-1447

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 3

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": "1258243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616976000000",
    "number": "1740517515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "670 MASON RIDGE CENTER DR",
            "address_2": "STE 300",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418573",
            "telephone_number": "314-996-4545",
            "fax_number": "314-996-4546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3009 N BALLAS RD STE 359C",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631312324",
            "telephone_number": "314-996-4545",
            "fax_number": "314-996-4546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLS",
        "first_name": "MARIA",
        "middle_name": "LENA",
        "credential": "ANP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-11-15",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MO",
            "license": "2004018016",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MO",
            "license": "2009034346",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3009 N Ballas Rd Ste 359C",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631312324",
            "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.