Individual provider Active NPI

Amy Lynn Lee, ANP

  • Nurse Practitioner
  • Saint Louis, MO
National Provider Identifier
1790050268
Registry record updated Apr 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
2012008033 Issued in MO
Practice address
12634 Olive Blvd
Div Surg Colon/Rectal
Saint Louis, MO 63141-6337
Phone
(314) 454-7177
Fax
(888) 425-7946
NPI assigned
Mar 17, 2012
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
Nurse Practitioner 363L00000X 2012008033 MO Primary

Addresses

Primary practice location

12634 Olive Blvd
Div Surg Colon/Rectal
Saint Louis, MO 63141-6337

Mailing address

PO Box 7412011
Chicago, IL 60674-2011
Phone (314) 454-7177

Other identifiers 1

IdentifierTypeStateIssuer
429593601MedicaidMO

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
I20120511000102 MO Practitioner - Nurse Practitioner 7719140607 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
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)

1040 N Mason Rd
Barnes Jewish W
St Louis, MO 63141-6399
Phone (314) 362-4533

Hospital & facility affiliations

  • Barnes-Jewish West County Hospital Hospital, Creve Coeur, MO, CCN 260162

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

State licenses

LicenseStateTypeSpecialty
2012008033MOMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Washington University CurrentSince Apr 1, 2017 Accepting new patients
Emergency Physicians of St. Luke'S, LLC Nurse Practitioner CurrentSince May 1, 2017 Accepting new patients
Physician Specialists of St Lukes LLC Past Accepting new patients

Locations

233 Clarkson Rd
Ellisville, MO 63011
Phone (636) 256-8644

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

660 S Euclid Ave
#C
Saint Louis, MO 63110

660 S Euclid Ave
#8109
Saint Louis, MO 63110
Phone (314) 362-7841

1040 N Mason Rd
Saint Louis, MO 63141
Phone (314) 362-4533

615 S New Ballas Rd
Saint Louis, MO 63141
Phone (314) 251-4687

12634 Olive Blvd
Saint Louis, MO 63141
Phone (314) 434-0600

660 S Euclid Ave
Saint Louis, MO 63110

1040 N Mason Rd
Ste 120
Saint Louis, MO 63141
Phone (314) 454-7177

Interoperability endpoints

  • Direct secure messaging: alee364710@directc.mercy.net

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 1

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": "1331942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744848000000",
    "number": "1790050268",
    "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": "314-454-7177",
            "fax_number": "888-425-7946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12634 OLIVE BLVD",
            "address_2": "DIV SURG COLON/RECTAL",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631416337",
            "telephone_number": "314-454-7177",
            "fax_number": "888-425-7946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "AMY",
        "middle_name": "LYNN",
        "name_prefix": "Ms.",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-17",
        "last_updated": "2025-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MO",
            "license": "2012008033",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "429593601",
            "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": "12634 Olive Blvd",
            "address_2": "Div Surg Colon/Rectal",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631416337",
            "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.