Individual provider Active NPI

Alicia D Hamilton, CPNP

  • Pediatric Nurse Practitioner
  • Saint Louis, MO
National Provider Identifier
1780602250
Registry record updated Feb 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
2000172304 Issued in MO
Practice address
1465 S Grand Blvd
4TH Floor Cardinal Glennon
Saint Louis, MO 63104-1003
Phone
(314) 457-7567
Fax
(314) 268-4163
NPI assigned
Jul 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 2000172304 MO Primary

Addresses

Primary practice location

1465 S Grand Blvd
4TH Floor Cardinal Glennon
Saint Louis, MO 63104-1003

Mailing address

1008 S Spring Ave # 3300
Saint Louis, MO 63110-2520
Phone (314) 977-8884

Other identifiers 1

IdentifierTypeStateIssuer
424024701MedicaidMO

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address ahamilton2161@direct-ehr-ssmhc.com Direct
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other

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
I20081025000045 MO Practitioner - Nurse Practitioner 8325106966 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
SSM Health Care Group CurrentSince Jul 1, 2022 Accepting new patients
SSM Health Care Group CurrentSince Jul 1, 2022 Accepting new patients

Locations

1465 S Grand Blvd
Saint Louis, MO 63104
Phone (314) 268-4070

1465 S Grand Blvd
Fl 4
Saint Louis, MO 63104
Phone (314) 457-7567

3635 Vista Ave
Fl 6
Saint Louis, MO 63110

3635 Vista Ave
Saint Louis, MO 63110
Phone (314) 577-8022

10101 Woodfield Ln
Saint Louis, MO 63132
Phone (608) 280-4647

Interoperability endpoints

  • Direct secure messaging: ahamilton2161@direct-ehr-ssmhc.com

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613692800000",
    "number": "1780602250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1008 S SPRING AVE # 3300",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631102520",
            "telephone_number": "314-977-8884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1465 S GRAND BLVD",
            "address_2": "4TH FLOOR CARDINAL GLENNON",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631041003",
            "telephone_number": "314-457-7567",
            "fax_number": "314-268-4163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAMILTON",
        "first_name": "ALICIA",
        "middle_name": "D",
        "name_prefix": "Ms.",
        "credential": "CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-17",
        "last_updated": "2021-02-19",
        "certification_date": "2021-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MO",
            "license": "2000172304",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "424024701",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ahamilton2161@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "ahamilton2161@direct-ehr-ssmhc.com",
            "address_1": "1465 S Grand Blvd",
            "address_2": "4th Floor Cardinal Glennon",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631041003",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "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": "1465 S Grand Blvd",
            "address_2": "4th Floor Cardinal Glennon",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631041003",
            "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.