Individual provider Active NPI

Elizabeth Ann Marie Conkling, PA

  • Physician Assistant
  • Saint Louis, MO
National Provider Identifier
1740762673
Registry record updated Apr 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2022012583 Issued in MO
Practice address
969 N Mason Rd
Div Im Dermatology, Ste 200
Saint Louis, MO 63141-6282
Phone
(314) 273-3376
Fax
(888) 682-0525
NPI assigned
Sep 6, 2018
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 2022012583 MO Primary

Addresses

Primary practice location

969 N Mason Rd
Div Im Dermatology, Ste 200
Saint Louis, MO 63141-6282

Mailing address

PO Box 7412011
Chicago, IL 60674-2011
Phone (314) 273-3376

Other identifiers 1

IdentifierTypeStateIssuer
220108824MedicaidMO

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
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
I20220503001157 MO Practitioner - Physician Assistant 5698027514 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Washington UniversityGroup PAC ID 9830008770, 2,968 clinicians

Practice addresses (Care Compare)

969 N Mason Rd
Barnes Jewish W County Dermatology
St Louis, MO 63141-6338
Phone (314) 996-8010

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 May 15, 2022 Accepting new patients
Washington University CurrentSince May 15, 2022 Accepting new patients
Washington University Past Accepting new patients

Locations

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

660 S Euclid Ave
Saint Louis, MO 63110

969 N Mason Rd
Ste 200
Saint Louis, MO 63141
Phone (314) 273-3376

660 S Euclid Ave
#8123
Saint Louis, MO 63110

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.

NPI Registry JSON

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

{
    "created_epoch": "1536192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744848000000",
    "number": "1740762673",
    "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": "314-273-3376",
            "fax_number": "888-682-0525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "969 N MASON RD",
            "address_2": "DIV IM DERMATOLOGY, STE 200",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631416282",
            "telephone_number": "314-273-3376",
            "fax_number": "888-682-0525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONKLING",
        "first_name": "ELIZABETH",
        "middle_name": "ANN MARIE",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-06",
        "last_updated": "2025-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2022012583",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "220108824",
            "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": "969 N Mason Rd",
            "address_2": "Div IM Dermatology, Ste 200",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631416282",
            "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.