Active NPI
Wilma J MC Clain
- Women's Health Nurse Practitioner
- Florissant, MO
National Provider Identifier
1962452920
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Women's Health Nurse Practitioner
- License
- 070184
- Practice address
- 3799 Afshari Cir
Florissant, MO 63034-1527 - Phone
- (314) 879-6300
- Fax
- (314) 879-6372
- NPI assigned
- May 11, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Women's Health Nurse Practitioner | 363LW0102X | 070184 | MO | Primary |
Addresses
Primary practice location
3799 Afshari Cir
Florissant, MO 63034-1527
Mailing address
5535 Delmar Blvd
Saint Louis, MO 63112-3005
Phone (314) 879-6300
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 427400601 | Medicaid | MO | |
| 815392931 | Medicaid | MO | |
| 1962452920 | Other | MO | NATIONAL PROVIDER IDENTIFIER |
| 11638556 | Other | MO | CAQH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Saint Louis Connectcare | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Endoscopy Clinic/Center
- Saint Louis, MO
- NPI 1679797237
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147305600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316390400000",
"number": "1962452920",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5535 DELMAR BLVD",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631123005",
"telephone_number": "314-879-6300",
"fax_number": "314-879-6372"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3799 AFSHARI CIR",
"city": "FLORISSANT",
"state": "MO",
"postal_code": "630341527",
"telephone_number": "314-879-6300",
"fax_number": "314-879-6372"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MC CLAIN",
"first_name": "WILMA",
"middle_name": "J",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-11",
"last_updated": "2011-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "363LW0102X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Women's Health",
"state": "MO",
"license": "070184",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "427400601",
"state": "MO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "815392931",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NATIONAL PROVIDER IDENTIFIER",
"identifier": "1962452920",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "11638556",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Florissant, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.