Active NPI
Mary Lynn Nielsen, M.D.
- Psychiatry Physician
- Clayton, MO
National Provider Identifier
1972645240
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- MDR7P10
- Practice address
- 225 S Meramec Ave
Suite 932T
Clayton, MO 63105-3511 - Phone
- (314) 721-7550
- Fax
- (314) 863-2114
- NPI assigned
- Feb 13, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | MDR7P10 | MO | Primary |
Addresses
Primary practice location
225 S Meramec Ave
Suite 932T
Clayton, MO 63105-3511
Mailing address
225 S Meramec Ave
Suite 932T
Clayton, MO 63105-3511
Phone (314) 721-7550
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| F31343 | Medicaid | MO | |
| 11589908 | Other | CAQH | |
| 111963 | Other | MO | BLUE CROSS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Oct 1, 2023 through Oct 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MDR7P10 | MO | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171324800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1972645240",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "225 S MERAMEC AVE",
"address_2": "SUITE 932T",
"city": "CLAYTON",
"state": "MO",
"postal_code": "631053511",
"telephone_number": "314-721-7550",
"fax_number": "314-863-2114"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "225 S MERAMEC AVE",
"address_2": "SUITE 932T",
"city": "CLAYTON",
"state": "MO",
"postal_code": "631053511",
"telephone_number": "314-721-7550",
"fax_number": "314-863-2114"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NIELSEN",
"first_name": "MARY",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MO",
"license": "MDR7P10",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "F31343",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "11589908",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "111963",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Clayton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.