Individual provider Active NPI

Diane M Eschmann-Morie, MD

  • Pediatrics Physician
  • Fenton, MO
National Provider Identifier
1902910292
Registry record updated Apr 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
110216 Issued in MO
Practice address
714 Gravois Rd
Ste 200
Fenton, MO 63026-7766
Phone
(636) 349-5437
Fax
(636) 349-6663
NPI assigned
Aug 17, 2006
Last updated
Apr 18, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 110216 MO Primary

Addresses

Primary practice location

714 Gravois Rd
Ste 200
Fenton, MO 63026-7766

Mailing address

PO Box 7412053
Chicago, IL 60674-2053
Phone (636) 349-5437

Other identifiers 1

IdentifierTypeStateIssuer
208554311MedicaidMO

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Washington University

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190326000732 MO Practitioner - Pediatric Medicine 8426398686 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
110216MOMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wuca-Fenton Pediatrics, LLC Pediatrics CurrentSince Apr 1, 2019 Accepting new patients

Locations

714 Gravois Rd
Ste 200
Fenton, MO 63026
Phone (636) 349-5437

4240 Duncan Ave
Ste 301
Saint Louis, MO 63110

Organizations & group practices 1

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744934400000",
    "number": "1902910292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7412053",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606742053",
            "telephone_number": "636-349-5437",
            "fax_number": "636-349-6663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "714 GRAVOIS RD",
            "address_2": "STE 200",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630267766",
            "telephone_number": "636-349-5437",
            "fax_number": "636-349-6663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ESCHMANN-MORIE",
        "first_name": "DIANE",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-17",
        "last_updated": "2025-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "110216",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208554311",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "714 Gravois Rd",
            "address_2": "STE 200",
            "city": "Fenton",
            "state": "MO",
            "country_code": "US",
            "postal_code": "630267766",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fenton, MO

Sources for this page

Verify at the official NPI Registry.