Individual provider Active NPI

Laura Beth Mulcahy, CNM

  • Advanced Practice Midwife
  • Maryville, IL
National Provider Identifier
1851927180
Registry record updated Sep 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice MidwifeTaxonomy code 367A00000X
License
2020009853 Issued in MO
Practice address
2023 Vadalabene Dr Ste 200
Maryville, IL 62062-5636
Phone
(618) 288-7408
Fax
(618) 288-7418
NPI assigned
Mar 18, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Midwife 176B00000X MO
Advanced Practice Midwife 367A00000X 2020009853 MO Primary

Addresses

Primary practice location

2023 Vadalabene Dr Ste 200
Maryville, IL 62062-5636

Mailing address

2023 Vadalabene Dr
Maryville, IL 62062-5630
Phone (618) 288-7408

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200515002401 MO Practitioner - Certified Nurse Midwife (CNM) 7911338462 Reassigns benefits to 1 organization
I20220311001839 IL Practitioner - Certified Nurse Midwife (CNM) 7911338462 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2020009853MOMDAdvanced Practice Midwife

Practice roles

OrganizationSpecialtyStatusNew patients
Christina L Midkiff MD SC CurrentSince Mar 3, 2022 Accepting new patients

Locations

2023 Vadalabene Dr
Ste 200
Maryville, IL 62062
Phone (618) 288-7408

734 Cambridge Blvd
O Fallon, IL 62269
Phone (618) 622-6196

Interoperability endpoints

  • Direct secure messaging: lmulcahy558409@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": "1584489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725926400000",
    "number": "1851927180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2023 VADALABENE DR",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620625630",
            "telephone_number": "618-288-7408",
            "fax_number": "618-288-7418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2023 VADALABENE DR STE 200",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620625636",
            "telephone_number": "618-288-7408",
            "fax_number": "618-288-7418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULCAHY",
        "first_name": "LAURA",
        "middle_name": "BETH",
        "credential": "CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-18",
        "last_updated": "2024-09-10",
        "certification_date": "2024-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "176B00000X",
            "taxonomy_group": "",
            "desc": "Midwife",
            "state": "MO",
            "license": null,
            "primary": false
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "MO",
            "license": "2020009853",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maryville, IL

Sources for this page

Verify at the official NPI Registry.