Individual provider Active NPI

Andrew G Wegener, PA-C

  • Physician Assistant
  • Wentzville, MO
National Provider Identifier
1760860209
Registry record updated Sep 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2016007767 Issued in MO
Practice address
1601 Wentzville Pkwy Ste 117
Wentzville, MO 63385-3814
Phone
(636) 332-8455
NPI assigned
May 18, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085.005405 IL
Physician Assistant 363A00000X 2016007767 MO Primary

Addresses

Primary practice location

1601 Wentzville Pkwy Ste 117
Wentzville, MO 63385-3814

Mailing address

PO Box 955534
Saint Louis, MO 63195-5534

Other practice location 1

800 E Carpenter St
Springfield, IL 62769-0002
Phone (414) 290-6720

Electronic endpoints 2

TypeEndpointUseAffiliation
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other
Direct Messaging Address awegener403668@direct-ehr-ssmhc.com Direct

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
I20160315002101 MO Practitioner - Physician Assistant 3072834332 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SSM Medical Group IncGroup PAC ID 6608776299, 565 clinicians

Practice addresses (Care Compare)

100 Medical PLZ
Lake Saint Louis, MO 63367-1366
Phone (636) 625-5200

1035 Bellevue Ave
Suite 500
Saint Louis, MO 63117-1843
Phone (314) 925-4770

801 Medical Dr
Suite 400
Wentzville, MO 63385-3824
Phone (636) 332-8455

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085.005405ILMDPhysician Assistant
2016007767MOMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
SSM Medical Group, Inc. CurrentSince Sep 1, 2021 Accepting new patients
SSM Medical Group Inc. CurrentSince Sep 1, 2021 Accepting new patients
SSM Health Care St. Louis Past Accepting new patients

Locations

1475 Kisker Rd
Ste 100
Saint Charles, MO 63304
Phone (636) 332-8455

400 1st Capitol Dr
Ste 100
Saint Charles, MO 63301
Phone (636) 332-8455

300 1st Capitol Dr
Saint Charles, MO 63301
Phone (636) 669-2211

3555 Sunset Office Dr
Ste C100
Saint Louis, MO 63127
Phone (314) 238-9100

1035 Bellevue Ave
Ste 500
Saint Louis, MO 63117
Phone (314) 647-1115

1601 Wentzville Pkwy
Ste 130
Wentzville, MO 63385
Phone (636) 332-8455

801 Medical Dr
Ste 400
Wentzville, MO 63385
Phone (636) 327-3100

Interoperability endpoints

  • Direct secure messaging: awegener744391@directc.mercy.net
  • Direct secure messaging: awegener403668@direct-ehr-ssmhc.com

Organizations & group practices 5

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": "1431907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632355200000",
    "number": "1760860209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 955534",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631955534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 WENTZVILLE PKWY STE 117",
            "city": "WENTZVILLE",
            "state": "MO",
            "postal_code": "633853814",
            "telephone_number": "636-332-8455"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 E Carpenter St",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "IL",
            "postal_code": "627690002",
            "country_code": "US",
            "telephone_number": "414-290-6720",
            "fax_number": "414-290-6755",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WEGENER",
        "first_name": "ANDREW",
        "middle_name": "G",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-05-18",
        "last_updated": "2021-09-23",
        "certification_date": "2021-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.005405",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2016007767",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "1601 Wentzville Pkwy Ste 117",
            "city": "Wentzville",
            "state": "MO",
            "country_code": "US",
            "postal_code": "633853814",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "awegener403668@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "awegener403668@direct-ehr-ssmhc.com",
            "address_1": "1601 Wentzville Pkwy Ste 117",
            "city": "Wentzville",
            "state": "MO",
            "country_code": "US",
            "postal_code": "633853814",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Wentzville, MO

Sources for this page

Verify at the official NPI Registry.