Individual provider Active NPI

Caroline Grace Nugent, MD

  • Hospitalist Physician
  • Wildwood, MO
National Provider Identifier
1790303493
Registry record updated Jun 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
2021042916 Issued in MO
Practice address
16555 Manchester Rd Ste 201
Wildwood, MO 63040-1220
Phone
(636) 458-5858
Fax
(636) 458-6510
NPI assigned
Jul 9, 2020
Last updated
Jun 5, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 2021042916 MO
Hospitalist Physician 208M00000X 2021042916 MO Primary

Addresses

Primary practice location

16555 Manchester Rd Ste 201
Wildwood, MO 63040-1220

Mailing address

PO Box 776084
Chicago, IL 60677-6084
Phone (636) 458-5858

Other practice location 1

1 Childrens Pl
Div Ped Hospitalist Med
Saint Louis, MO 63110-1002
Phone (314) 454-2076

Other identifiers 1

IdentifierTypeStateIssuer
200083457MedicaidMO

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, IL2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230720000376 MO Practitioner - Pediatric MedicinePractitioner - Other (Physician) 7416317631 Reassigns benefits to 2 organizations
I20230929000474 IL Practitioner - Pediatric Medicine 7416317631 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Washington University CurrentSince Jun 17, 2023 Accepting new patients
Washington University Physicians in Illinois, Inc CurrentSince Sep 6, 2023 Accepting new patients
Washington University Physicians in Illinois, Inc Current Accepting new patients
Washington University Physicians in Illinois, Inc CurrentSince Sep 6, 2023 Accepting new patients
Mercy Clinic East Communities Pediatrics CurrentSince Jun 3, 2024 Accepting new patients
Washington University CurrentSince Jun 17, 2023 Accepting new patients

Locations

4500 Memorial Dr
Belleville, IL 62226
Phone (618) 233-7750

1 Childrens Pl
Saint Louis, MO 63110
Phone (314) 454-2076

1 Childrens Pl
#3S34
Saint Louis, MO 63110
Phone (314) 454-6006

1 Childrens Pl
Ste C
Saint Louis, MO 63110
Phone (314) 454-2104

621 S New Ballas Rd
Ste 4017B
Saint Louis, MO 63141
Phone (314) 872-9192

660 S Euclid Ave
Saint Louis, MO 63110

16555 Manchester Rd
Ste 201
Wildwood, MO 63040
Phone (636) 458-0040

Organizations & group practices 6

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": "1594252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717545600000",
    "number": "1790303493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776084",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606776084",
            "telephone_number": "636-458-5858",
            "fax_number": "636-458-6510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16555 MANCHESTER RD STE 201",
            "city": "WILDWOOD",
            "state": "MO",
            "postal_code": "630401220",
            "telephone_number": "636-458-5858",
            "fax_number": "636-458-6510"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Childrens Pl",
            "address_2": "Div Ped Hospitalist Med",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631101002",
            "country_code": "US",
            "telephone_number": "314-454-2076",
            "fax_number": "314-747-8953",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NUGENT",
        "first_name": "CAROLINE",
        "middle_name": "GRACE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-09",
        "last_updated": "2024-06-05",
        "certification_date": "2024-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2021042916",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MO",
            "license": "2021042916",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200083457",
            "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": "1 Childrens Pl",
            "address_2": "Div Ped Hospitalist Med",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631101002",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Wildwood, MO

Sources for this page

Verify at the official NPI Registry.