Individual provider Active NPI

Angela Katherine Severado, FNP-BC AND PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Saint Louis, MO
National Provider Identifier
1952787376
Registry record updated May 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
277.001329 Issued in IL
Practice address
1 Jefferson Barracks Rd
Saint Louis, MO 63125-4181
Phone
(314) 652-4100
NPI assigned
Aug 7, 2015
Last updated
May 6, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 6, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 277.001329 IL Primary

Addresses

Primary practice location

1 Jefferson Barracks Rd
Saint Louis, MO 63125-4181

Mailing address

1660 Shadow Ridge CT Apt 10
Belleville, IL 62221-3905
Phone (217) 816-7928

Other practice location 1

1124 S 6th St
Springfield, IL 62703-2406
Phone (217) 523-3143

Other identifiers 1

IdentifierTypeStateIssuer
309.008660MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20150902001972 IL Practitioner - Nurse Practitioner 3779899943 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
TMS Neurohealth Illinois PLLCGroup PAC ID 8729412689, 2 clinicians

Practice addresses (Care Compare)

303 Fountains Pkwy
Suite 200
Fairview Heights, IL 62208-2074
Phone (618) 688-7020

Merit-based Incentive Payment System (MIPS)

Final score
79.44 of 100Reported as group
Quality
71.79
Promoting interoperability
77
Improvement activities
40
Cost
75.71

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
277.001329ILMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
HSHS Medical Group Inc CurrentSince Oct 8, 2018 Accepting new patients
Divine Design Psychiatry and Wellness PLLC Psychiatric/Mental Health Current Accepting new patients
Psychological Associates of Central Illinois LTD CurrentSince Dec 6, 2022 Accepting new patients
TMS Neurohealth Illinois PLLC CurrentSince Apr 24, 2024 Accepting new patients
HSHS Medical Group Inc CurrentSince Oct 8, 2018 Accepting new patients

Locations

1900 E Lake Shore Dr
Ste 330
Decatur, IL 62521
Phone (217) 423-2889

303 Fountains Pkwy
Ste 200
Fairview Hts, IL 62208
Phone (618) 688-7020

1124 S 6th St
Springfield, IL 62703
Phone (217) 523-3143

701 N Walnut St
Springfield, IL 62702
Phone (217) 528-1217

800 E Carpenter St
Springfield, IL 62769
Phone (217) 525-5643

Interoperability endpoints

  • Direct secure messaging: greenbrooktmsmo.angelaseverado@158455.advancedmd-direct.com

Organizations & group practices 5

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": "1438905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714953600000",
    "number": "1952787376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1660 SHADOW RIDGE CT APT 10",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622213905",
            "telephone_number": "217-816-7928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 JEFFERSON BARRACKS RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631254181",
            "telephone_number": "314-652-4100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1124 S 6th St",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "IL",
            "postal_code": "627032406",
            "country_code": "US",
            "telephone_number": "217-523-3143",
            "fax_number": "217-523-1513",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SEVERADO",
        "first_name": "ANGELA",
        "middle_name": "KATHERINE",
        "name_prefix": "Ms.",
        "credential": "FNP-BC AND PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-08-07",
        "last_updated": "2024-05-06",
        "certification_date": "2024-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "277.001329",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "309.008660",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.