Individual provider Active NPI

Julie Ann Neidich, MD

  • Molecular Genetic Pathology (Pathology) Physician
  • Saint Louis, MO
National Provider Identifier
1962690180
Registry record updated Apr 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Molecular Genetic Pathology (Pathology) PhysicianTaxonomy code 207ZP0007X
License
2017022702 Issued in MO
Practice address
4320 Forest Park Ave
Div PA, Genomic and Molecular Pathology, Ste 209
Saint Louis, MO 63108-2979
Phone
(314) 362-5641
Fax
(314) 362-0369
NPI assigned
Oct 12, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Molecular Genetic Pathology (Pathology) Physician 207ZP0007X 2017022702 MO Primary

Addresses

Primary practice location

4320 Forest Park Ave
Div PA, Genomic and Molecular Pathology, Ste 209
Saint Louis, MO 63108-2979

Mailing address

PO Box 7412011
Chicago, IL 60674-2011
Phone (314) 362-5641

Other identifiers 1

IdentifierTypeStateIssuer
200090687MedicaidMO

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
I20170825000616 MO Practitioner - Pathology 4385916337 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2017022702MOMDMolecular Genetic Pathology (Pathology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Washington University CurrentSince Aug 1, 2017 Accepting new patients
Washington University CurrentSince Aug 1, 2017 Accepting new patients

Locations

4320 Forest Park Ave
Ste 209
Saint Louis, MO 63108

1 Barnes Jewish Hospital Plz
#P
Saint Louis, MO 63110
Phone (618) 474-1074

1 Barnes Hospital Plz
Saint Louis, MO 63110
Phone (314) 362-9170

660 S Euclid Ave
#8118
Saint Louis, MO 63110
Phone (314) 362-0101

1 Barnes Jewish Hospital Plz
Fl 3
Saint Louis, MO 63110

660 S Euclid Ave
#C
Saint Louis, MO 63110

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1192147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744848000000",
    "number": "1962690180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7412011",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606742011",
            "telephone_number": "314-362-5641",
            "fax_number": "314-362-0369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4320 FOREST PARK AVE",
            "address_2": "DIV PA, GENOMIC AND MOLECULAR PATHOLOGY, STE 209",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631082979",
            "telephone_number": "314-362-5641",
            "fax_number": "314-362-0369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEIDICH",
        "first_name": "JULIE",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-12",
        "last_updated": "2025-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0007X",
            "taxonomy_group": "",
            "desc": "Pathology, Molecular Genetic Pathology",
            "state": "MO",
            "license": "2017022702",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200090687",
            "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": "4320 Forest Park Ave",
            "address_2": "Div PA, Genomic and Molecular Pathology, Ste 209",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631082979",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.