Active NPI
Olivia Beaubrun, MD
- Pediatrics Physician
- Saint Louis, MO
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 2017019821
- Practice address
- 1 Childrens PL # 3S34
Saint Louis, MO 63110-1002 - Phone
- (314) 454-6006
- Fax
- (314) 454-4102
- NPI assigned
- Jun 26, 2017
- Last updated
- Nov 17, 2025
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | D0097619 | MD | |
| Pediatrics Physician | 208000000X | 2017019821 | MO | Primary |
Addresses
Primary practice location
1 Childrens PL # 3S34
Saint Louis, MO 63110-1002
Mailing address
40 N Kingshighway Blvd Apt 3N
Saint Louis, MO 63108-1348
Other practice location 1
1 Childrens Pl
Saint Louis, MO 63110-1002
Phone (314) 454-6000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY, DC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D0097619 | MD | MD | Emergency Medicine Physician |
| 2017019821 | MO | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Physician Affiliate Group of New York PC | Current | Accepting new patients | |
| Cep America LLC | Emergency Medicine | Current | Accepting new patients |
| Mep Health, LLC | Emergency Medicine | Current | Accepting new patients |
| Cep America LLC | Emergency Medicine | Current | Accepting new patients |
| Cep America LLC | Emergency Medicine | Current | Accepting new patients |
Locations
1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 900-3125
2041 Georgia Ave NW
Washington, DC 20060
Phone (202) 865-3785
9901 Medical Center Dr
Rockville, MD 20850
Phone (301) 279-6000
2601 Ocean Pkwy
Brooklyn, NY 11235
Phone (718) 616-5354
506 Malcolm X Blvd
New York, NY 10037
Phone (212) 939-1000
Networks
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H3359
Interoperability endpoints
- obeaubrun1339627@nychhc.direct-ci.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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1498435200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1763337600000",
"number": "1962922336",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "40 N KINGSHIGHWAY BLVD APT 3N",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631081348"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 CHILDRENS PL # 3S34",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631101002",
"telephone_number": "314-454-6006",
"fax_number": "314-454-4102"
}
],
"practiceLocations": [
{
"address_1": "1 Childrens Pl",
"address_purpose": "LOCATION",
"city": "Saint Louis",
"state": "MO",
"postal_code": "631101002",
"country_code": "US",
"telephone_number": "314-454-6000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BEAUBRUN",
"first_name": "OLIVIA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-06-26",
"last_updated": "2025-11-17",
"certification_date": "2025-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "MD",
"license": "D0097619",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MO",
"license": "2017019821",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.