NPIMap

Individual provider Active NPI

Gary A Vickers, DO

  • Family Medicine Physician
  • Chesterfield, MO
National Provider Identifier
1902867633
Registry record updated Jan 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
108736 Issued in MO
Practice address
224 S Woods Mill Rd Ste 435S
Chesterfield, MO 63017-3408
Phone
(314) 576-2394
Fax
(314) 590-5937
NPI assigned
Mar 31, 2006
Last updated
Jan 25, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 108736 MO Primary
Hospitalist Physician 208M00000X 108736 MO

Addresses

Primary practice location

224 S Woods Mill Rd Ste 435S
Chesterfield, MO 63017-3408

Mailing address

1551 Wall St
Suite 310
Saint Charles, MO 63303-3539
Phone (636) 669-2268

Other identifiers 2

IdentifierTypeStateIssuer
1902867633MedicaidIL
1902867633MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040915000072 MO Practitioner - Family Practice 6406823889 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Woods Mill Medical Associates, LLCGroup PAC ID 0749441830, 6 clinicians

Practice addresses (Care Compare)

15201 Olive Blvd
Chesterfield, MO 63017-1810
Phone (636) 898-8531

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.71 of 100Reported as apm
Quality
82.25
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Physicians of St. Luke's, LLC Family Medicine CurrentSince Jul 1, 2020 Accepting new patients
Woods Mill Medical Associates, LLC CurrentSince Nov 9, 2020 Accepting new patients
St. Lukes Medical Group Family Medicine Past Accepting new patients
Physician Specialists of St Lukes LLC Family Medicine Past Accepting new patients
Arnold S Tepper Inc Past Accepting new patients
Mercy Clinic East Communities Family Medicine Past Accepting new patients
St. Anthony's Physician Organization Family Medicine Past Accepting new patients

Locations

15201 Olive Blvd
Chesterfield, MO 63017
Phone (636) 532-1515

224 S Woods Mill Rd
Ste 435S
Chesterfield, MO 63017
Phone (314) 392-4762

233 Clarkson Rd
Ellisville, MO 63011
Phone (636) 256-8644

Organizations & group practices 7

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.

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": "1143763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611532800000",
    "number": "1902867633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1551 WALL ST",
            "address_2": "SUITE 310",
            "city": "SAINT CHARLES",
            "state": "MO",
            "postal_code": "633033539",
            "telephone_number": "636-669-2268",
            "fax_number": "314-209-8127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "224 S WOODS MILL RD STE 435S",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630173408",
            "telephone_number": "314-576-2394",
            "fax_number": "314-590-5937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VICKERS",
        "first_name": "GARY",
        "middle_name": "A",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-31",
        "last_updated": "2021-01-25",
        "certification_date": "2021-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "108736",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MO",
            "license": "108736",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1902867633",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1902867633",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chesterfield, MO

Sources for this page

Verify at the official NPI Registry.