Active NPI
Jennifer Dawn Krick, M.D.
- Pediatrics Physician
- Maryville, IL
National Provider Identifier
1851591523
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 2005034034
- Practice address
- 6828 State Route 162
Maryville, IL 62062-8500 - Phone
- (618) 288-5084
- Fax
- (618) 288-8045
- NPI assigned
- Jul 20, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 2005034034 | MO | Primary |
Addresses
Primary practice location
6828 State Route 162
Maryville, IL 62062-8500
Mailing address
10777 Sunset Office Dr
Suite 310
Saint Louis, MO 63127-1019
Phone (314) 822-5900
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036181252 | Medicaid | IL |
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2005034034 | MO | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| SSM Health Care St. Louis | Pediatrics | Past | Accepting new patients |
| SSM Medical Group | Past | Accepting new patients | |
| SSM Medical Group | Past | Accepting new patients |
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.
-
dba SSM Health St. Joseph Hospital - St. Charles Physician Billing
- Emergency Medicine Physician
- Saint Charles, MO
- NPI 1427002922
Pediatrics
-
dba Family Practice of South County
- Family Medicine Physician
- Fenton, MO
- NPI 1275781288
-
dba SSM Women's Center
- Multi-Specialty Clinic/Center
- Saint Louis, MO
- NPI 1316953656
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184889600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1251936000000",
"number": "1851591523",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10777 SUNSET OFFICE DR",
"address_2": "SUITE 310",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631271019",
"telephone_number": "314-822-5900",
"fax_number": "314-822-5919"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6828 STATE ROUTE 162",
"city": "MARYVILLE",
"state": "IL",
"postal_code": "620628500",
"telephone_number": "618-288-5084",
"fax_number": "618-288-8045"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRICK",
"first_name": "JENNIFER",
"middle_name": "DAWN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-07-20",
"last_updated": "2009-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MO",
"license": "2005034034",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036181252",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Maryville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.