Individual provider Active NPI

Amy Guan, MS, APN

  • Gerontology Nurse Practitioner
  • Saint Louis, MO
National Provider Identifier
1801398813
Registry record updated Sep 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
2023012036 Issued in MO
Practice address
12348 Old Tesson Rd Ste 250
Saint Louis, MO 63128-2261
Phone
(314) 272-2727
NPI assigned
Mar 6, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X 209016579 IL
Primary Care Nurse Practitioner 363LP2300X 2023014672 MO
Gerontology Nurse Practitioner 363LG0600X 2023012036 MO Primary

Addresses

Primary practice location

12348 Old Tesson Rd Ste 250
Saint Louis, MO 63128-2261

Mailing address

PO Box 776084
Chicago, IL 60677-6084
Phone (314) 272-2727

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, MO2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20180726001538 IL Practitioner - Nurse Practitioner 2567719248 Reassigns benefits to 1 organization
I20230926001254 MO Practitioner - Nurse Practitioner 2567719248 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mercy Clinic East CommunitiesGroup PAC ID 7214827922, 573 clinicians

Practice addresses (Care Compare)

12348 Old Tesson Rd
Suite 250
Saint Louis, MO 63128-2261
Phone (314) 272-2727

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
2023012036MOMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Access Community Health Network CurrentSince Jun 12, 2018 Accepting new patients
Access Community Health Network Current Accepting new patients
Mercy Clinic East Communities CurrentSince Sep 5, 2023 Accepting new patients
Access Community Health Network CurrentSince Jun 12, 2018 Accepting new patients

Locations

600 W Fulton St
Ste 200
Chicago, IL 60661
Phone (312) 526-2000

4839 W 47th St
Chicago, IL 60638
Phone (773) 735-2345

12348 Old Tesson Rd
Ste 240
Saint Louis, MO 63128
Phone 3144673900 ext. 284

621 S New Ballas Rd
Ste 189A
Saint Louis, MO 63141
Phone (314) 251-6335

12348 Old Tesson Rd
Ste 250
Saint Louis, MO 63128
Phone (314) 272-2727

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

Organizations & group practices 4

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": "1520294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694390400000",
    "number": "1801398813",
    "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": "314-272-2727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12348 OLD TESSON RD STE 250",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631282261",
            "telephone_number": "314-272-2727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUAN",
        "first_name": "AMY",
        "credential": "MS, APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-06",
        "last_updated": "2023-09-11",
        "certification_date": "2023-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "IL",
            "license": "209016579",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MO",
            "license": "2023014672",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MO",
            "license": "2023012036",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.