Individual provider Active NPI

Theresa Lee McQuaide, ANP

  • Adult Health Nurse Practitioner
  • Saint Louis, MO
National Provider Identifier
1770692048
Registry record updated Nov 27, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
117389 Issued in MO
Practice address
13065 Old Tesson Ferry Rd
Saint Louis, MO 63128-3441
Phone
(314) 543-5222
NPI assigned
Aug 30, 2006
Last updated
Nov 27, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2013

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Registered Nurse 163WG0000X RN117389 MO
General Practice Registered Nurse 163WG0000X 041-331941 IL
Clinical Nurse Specialist 364S00000X 209-004439 IL
Adult Health Nurse Practitioner 363LA2200X 209-005264 IL
Adult Health Nurse Practitioner 363LA2200X 117389 MO Primary

Addresses

Primary practice location

13065 Old Tesson Ferry Rd
Saint Louis, MO 63128-3441

Mailing address

13065 Old Tesson Ferry Rd
Saint Louis, MO 63128-3441
Phone (314) 543-5222

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
041-331941ILMDGeneral Practice Registered Nurse
RN117389MOMDGeneral Practice Registered Nurse
209-005264ILMDAdult Health Nurse Practitioner
117389MOMDAdult Health Nurse Practitioner
209-004439ILMDClinical Nurse Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
American Multispecialty Group Inc. Adult Health CurrentSince Aug 6, 1996 Accepting new patients
Washington University Past Accepting new patients

Locations

2900 Frank Scott Pkwy W
Ste 914
Belleville, IL 62223
Phone (618) 277-1413

1167 Fortune Blvd
Shiloh, IL 62269
Phone (618) 207-6900

5034 Griffin Rd
Saint Louis, MO 63128
Phone (314) 843-7333

9930 Watson Rd
Saint Louis, MO 63126
Phone (314) 984-8827

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1385510400000",
    "number": "1770692048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13065 OLD TESSON FERRY RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631283441",
            "telephone_number": "314-543-5222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13065 OLD TESSON FERRY RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631283441",
            "telephone_number": "314-543-5222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCQUAIDE",
        "first_name": "THERESA",
        "middle_name": "LEE",
        "name_prefix": "Ms.",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2013-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "MO",
            "license": "RN117389",
            "primary": false
        },
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "IL",
            "license": "041-331941",
            "primary": false
        },
        {
            "code": "364S00000X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist",
            "state": "IL",
            "license": "209-004439",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IL",
            "license": "209-005264",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MO",
            "license": "117389",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.