Nickolas Bacon, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

2024001495 Issued in MO

Practice address

1400 US Highway 61
Festus, MO 63028-4100

Phone

(636) 933-5337

NPI assigned

Jun 17, 2021

Last updated

Aug 5, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Internal Medicine

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mercy Clinic Adult Hospitalists Jefferson LLCGroup PAC ID 8628205598, 58 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mercy Hospital Jefferson Hospital, Crystal City, MO, CCN 260023
• Mercy Hospital South Hospital, Saint Louis, MO, CCN 260077
• Parkland Health Center Hospital, Farmington, MO, CCN 260163

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Mercy Clinic Adult Hospitalists- Jefferson, LLC

  • Internal Medicine Physician
  • Festus, MO
  • NPI 1083052492
  Medicare reassignment Care Compare group NPD
• Mercy Clinic Adult Hospitalists - St. Louis, LLC

  • Internal Medicine Physician
  • Saint Louis, MO
  • NPI 1841235108
  Medicare reassignment NPD
• Mercy Clinic Adult Hospitalists - Washington, LLC

  • Hospitalist Physician
  • Washington, MO
  • NPI 1891943429
  Medicare reassignment NPD
• Mercy Hospitals East Communities

  dba Mercy JFK Clinic

  • Clinic/Center
  • Saint Louis, MO
  • NPI 1851431738
  Medicare reassignment NPD
• St Anthonys Physician Organization Hospitalist Services, L.C.

  dba Mercy Clinic South Hospitalists

  • Hospitalist Physician
  • Saint Louis, MO
  • NPI 1407216336
  Medicare reassignment NPD
• Mercy Hospitals East Communities

  dba Mercy St. Louis Transport Ambulance

  • Land Ambulance
  • Saint Louis, MO
  • NPI 1881329902
  NPD
• Mercy Hospital Jefferson

  • General Acute Care Hospital
  • Festus, MO
  • NPI 1508859661
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Mercy Hospital Jefferson

  • General Acute Care Hospital
  • Festus, MO
  • NPI 1508859661
  Care Compare affiliation
• Mercy Hospital South

  • General Acute Care Hospital
  • Saint Louis, MO
  • NPI 1568481984
  Care Compare affiliation
• Parkland Health Center

  dba Parkland Health Center - Farmington

  • General Acute Care Hospital
  • Farmington, MO
  • NPI 1003824061
  Care Compare affiliation
• Parkland Health Center

  dba Parkland Health Center - Farmington

  • Psychiatric Hospital Unit
  • Farmington, MO
  • NPI 1902814866
  Care Compare affiliation

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

{
    "created_epoch": "1623888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722816000000",
    "number": "1972172666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 US HIGHWAY 61 STE H1521",
            "city": "FESTUS",
            "state": "MO",
            "postal_code": "630284100",
            "telephone_number": "636-933-5337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 US HIGHWAY 61",
            "city": "FESTUS",
            "state": "MO",
            "postal_code": "630284100",
            "telephone_number": "636-933-5337"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "615 S New Ballas Rd",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631418221",
            "country_code": "US",
            "telephone_number": "314-251-6339",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10010 Kennerly Rd",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631282106",
            "country_code": "US",
            "telephone_number": "314-525-1328",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "901 E 5th St",
            "address_purpose": "LOCATION",
            "city": "Washington",
            "state": "MO",
            "postal_code": "630903127",
            "country_code": "US",
            "telephone_number": "636-239-8231",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BACON",
        "first_name": "NICKOLAS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-17",
        "last_updated": "2024-08-05",
        "certification_date": "2024-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2024001495",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Austin, MA, LPC, CTTS
• Amanda E Avellone, MD
• Axes Physical Therapy, LLC (Axes Physical Therapy)
• Axes Physical Therapy, LLC (Axes Physical Therapy)
• Muhammad Azharuddin, MD
• Julia Ellen Bahr, LPC NCC
• Glenna J Bailey
• Elaine Baker
• Matthew Baker, MD
• Ammar Barakat, M.D

• Internal Medicine Physician in Festus, MO
• Providers in Festus, MO by specialty
• Internal Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2024; 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.
• 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.