Individual provider Active NPI

Elizabeth Deiters Young, NP

  • Primary Care Nurse Practitioner
  • Saint Louis, MO
National Provider Identifier
1871045914
Registry record updated Oct 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
2016036411 Issued in MO
Practice address
621 S New Ballas Rd
Suite 507a
Saint Louis, MO 63141-8232
Phone
(314) 251-5780
NPI assigned
Oct 25, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X 2016036411 MO Primary

Addresses

Primary practice location

621 S New Ballas Rd
Suite 507a
Saint Louis, MO 63141-8232

Mailing address

621 S New Ballas Rd
Suite 507a
Saint Louis, MO 63141-8232

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
I20161027000772 MO Practitioner - Nurse Practitioner 9234417106 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Physical Therapy Spine and Sports Medicine LLCGroup PAC ID 3173654936, 123 clinicians
Mercy Clinic East CommunitiesGroup PAC ID 7214827922, 573 clinicians

Practice addresses (Care Compare)

15425 Manchester Rd
Suite 28
Ballwin, MO 63011-3077
Phone (636) 220-6969

621 S New Ballas Rd
Suite 507a
Saint Louis, MO 63141-8260
Phone (614) 251-5780

Hospital & facility affiliations

  • Mercy Hospital St Louis Hospital, Saint Louis, MO, CCN 260020
  • Mercy Hospital South Hospital, Saint Louis, MO, CCN 260077

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
2016036411MOMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic East Communities CurrentSince Oct 24, 2016 Accepting new patients

Locations

621 S New Ballas Rd
Ste 507A
Saint Louis, MO 63141
Phone (314) 251-6800

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

10024 Watson Rd
Saint Louis, MO 63126
Phone (314) 919-2273

4280 Mid America Ln
Ste 30
Saint Louis, MO 63129
Phone (314) 782-2600

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

Interoperability endpoints

  • Direct secure messaging: edeiters357412@directc.mercy.net

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.

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": "1477353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477353600000",
    "number": "1871045914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 S NEW BALLAS RD",
            "address_2": "SUITE 507A",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 S NEW BALLAS RD",
            "address_2": "SUITE 507A",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418232",
            "telephone_number": "314-251-5780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUNG",
        "first_name": "ELIZABETH",
        "middle_name": "DEITERS",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-25",
        "last_updated": "2016-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MO",
            "license": "2016036411",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.