Andrea R Sample, MD

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

2006012211 Issued in MO

Practice address

12277 De Paul Dr Ste 305
Bridgeton, MO 63044-2529

Phone

(314) 344-7585

NPI assigned

Sep 21, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Andrea R Jefferson Former name

Electronic endpoints 2

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

Obstetrics/Gynecology

Education

University of Missouri, Kansas City, School of Medicine, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

SSM Medical Group IncGroup PAC ID 6608776299, 565 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• SSM Health Depaul Hospital St Louis Hospital, Bridgeton, MO, CCN 260104

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: asample2588@direct-ehr-ssmhc.com
• FHIR API: https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

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.

• SSM Medical Group, Inc.

  • Multi-Specialty Clinic/Center
  • Fenton, MO
  • NPI 1700966207
  Medicare reassignment Care Compare group NPD
• SSM Health Care St Louis

  • Emergency Medicine Physician
  • Fenton, MO
  • NPI 1275586174
  Medicare reassignment NPD
• SSM Medical Group Inc.

  • Durable Medical Equipment & Medical Supplies
  • Warrenton, MO
  • NPI 1467997155
  NPD
• Missouri Baptist Medical Center

  • General Acute Care Hospital
  • Saint Louis, MO
  • NPI 1487663506
  NPD (past)
• SSM Depaul Medical Group, Inc.

  • Family Medicine Physician
  • Florissant, MO
  • NPI 1952312951
  NPD (past)
• SSM Health Care St. Louis

  • Emergency Medicine Physician
  • Saint Charles, MO
  • NPI 1427002922

  Obstetrics & Gynecology

  NPD (past)

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

• SSM Health Care St. Louis

  • General Acute Care Hospital
  • Bridgeton, MO
  • NPI 1598835308
  Care Compare affiliation

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603670400000",
    "number": "1972602761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 955534",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631955534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12277 DE PAUL DR STE 305",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442529",
            "telephone_number": "314-344-7585"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "493 Saint Francois St",
            "address_2": "Suite 2",
            "address_purpose": "LOCATION",
            "city": "Florissant",
            "state": "MO",
            "postal_code": "630315043",
            "country_code": "US",
            "telephone_number": "314-972-9888",
            "fax_number": "314-972-9880",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SAMPLE",
        "first_name": "ANDREA",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-21",
        "last_updated": "2020-10-26",
        "certification_date": "2020-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MO",
            "license": "2006012211",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MO",
            "license": "2006012211",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MISSOUIR LICENSE",
            "identifier": "2006012211",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "asample2588@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "asample2588@direct-ehr-ssmhc.com",
            "address_1": "12277 De Paul Dr Ste 305",
            "city": "Bridgeton",
            "state": "MO",
            "country_code": "US",
            "postal_code": "630442529",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "12277 De Paul Dr Ste 305",
            "city": "Bridgeton",
            "state": "MO",
            "country_code": "US",
            "postal_code": "630442529",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ANDREA",
            "last_name": "JEFFERSON",
            "middle_name": "R",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Katie Schaefer, NP

• Obstetrics & Gynecology Physician in Bridgeton, MO
• Providers in Bridgeton, MO by specialty
• Obstetrics & Gynecology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2020; 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.