NPIMap

Organization Active NPI

Bonne Terre Healthcare Clinic LLC

  • Family Nurse Practitioner
  • Bonne Terre, MO
National Provider Identifier
1962043802
Registry record updated Feb 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
BONNE TERRE HEALTHCARE CLINIC LLC
Practice address
11 S Division St Ste a
Bonne Terre, MO 63628-1701
Phone
(573) 723-1100
Fax
(573) 723-1130
NPI assigned
Oct 2, 2019
Last updated
Feb 25, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2024

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

Authorized official

Name
Mary Elizabeth Chandler, DNP FNP-C PMHNP-BCNPI 1780082206
Title
Owner/Provider
Phone
(573) 723-1100

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X Primary
Pediatric Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0200X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X
Primary Care Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP2300X
Women's Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LW0102X

Addresses

Primary practice location

11 S Division St Ste a
Bonne Terre, MO 63628-1701

Mailing address

11 S Division St Ste a
Bonne Terre, MO 63628-1701
Phone (573) 723-1100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200217001228 MO Part B Supplier - Clinic/Group Practice 6103253919 Receives reassigned benefits from 8 practitioners
Practice locations: Bonne Terre, MO

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D2178139Bonne Terre Healthcare Clinic, LLC11 S Division St, Suite a, Bonne Terre, MO 63628Certificate of waiverJan 27, 2028

National Provider Directory

National Provider Directory

Locations

11 S Division St
Ste A
Bonne Terre, MO 63628
Phone (573) 723-1100

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/20393/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1569974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708819200000",
    "number": "1962043802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 S DIVISION ST STE A",
            "city": "BONNE TERRE",
            "state": "MO",
            "postal_code": "636281701",
            "telephone_number": "573-723-1100",
            "fax_number": "573-723-1130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 S DIVISION ST STE A",
            "city": "BONNE TERRE",
            "state": "MO",
            "postal_code": "636281701",
            "telephone_number": "573-723-1100",
            "fax_number": "573-723-1130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BONNE TERRE HEALTHCARE CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-02",
        "last_updated": "2024-02-25",
        "certification_date": "2024-02-25",
        "status": "A",
        "authorized_official_last_name": "CHANDLER",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "573-723-1100",
        "authorized_official_credential": "DNP FNP-C PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LW0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Women's Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bonne Terre, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.