Mary Withoelter – Nurse Practitioner

Key facts

NPI: 1982188389
Entity type: Individual (NPI type 1)
Primary specialty: Nurse Practitioner 363L00000X
License: 2019033706 (MO)
Practice address: 2630 State Highway K
Ofallon, MO 63368
Phone: (636) 980-5300
Fax: (636) 980-5344
NPI assigned: Sep 20, 2018
Sex: Female
Sole proprietor: No

Organizations & group practices 6

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.

Physician Groups LC Multi-Specialty Clinic/Center · Saint Louis, MO · NPI 1285664268

Medicare reassignment Care Compare group NPD MO
Total Access Urgent Care, PC Urgent Care Clinic/Center · Saint Louis, MO · NPI 1962684886

Medicare reassignment Care Compare group NPD MO
Ut Regional One Physicians Inc Surgery Physician · Memphis, TN · NPI 1093130585

Medicare reassignment NPD NURSE PRACTITIONER · TN
Physician Groups LC Multi-Specialty Clinic/Center · Farmington, MO · NPI 1427114990

NPD
Total Access Urgent Care, PC Urgent Care Clinic/Center · Saint Louis, MO · NPI 1952729402

NPD
Ut Regional One Physicians Inc Anesthesiology Physician · Memphis, TN · NPI 1285042028

NPD

Medicare Care Compare profile

Specialty: Nurse Practitioner
Education: Other, 2018
Medicare assignment: Accepts the Medicare-approved amount as payment in full
Group practices: Physician Groups LC (526 clinicians)
Total Access Urgent Care PC (130 clinicians)

Practice addresses (Care Compare)

1110 Highlands Plaza Dr E
Saint Louis, MO 63110-1351
Phone (314) 273-0195

1520 Wentzville Pkwy
Wentzville, MO 63385-3408
Phone (636) 497-4000

2630 Hwy K
O Fallon, MO 63368-6624
Phone (636) 240-5454

9556 Manchester Rd
Saint Louis, MO 63119-1313
Phone (314) 961-2255

Merit-based Incentive Payment System (MIPS)

Final score: 42.87 of 100 (group)
Quality: 31.86
Promoting interoperability: 0
Improvement activities: 40
Cost: 61.04

Medicare participation

Medicare fee-for-service enrollment: Enrolled (2 enrollments) in TN, MO
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20190213002978	TN	Practitioner - Nurse Practitioner	1456699651	Reassigns benefits to 1 organization
I20200316000939	MO	Practitioner - Nurse Practitioner	1456699651	Reassigns benefits to 2 organizations

National Provider Directory

Medicare enrollment (NPD): Yes

Practice roles

Organization	Specialty	Status	New patients
Total Access Urgent Care, PC		Current since Feb 7, 2020	Accepting new patients
Ut Regional One Physicians Inc		Current since Jan 7, 2019	Accepting new patients
Ut Regional One Physicians Inc	Nurse Practitioner	Current since Jan 7, 2019	Accepting new patients
Physician Groups LC		Current since May 1, 2025	Accepting new patients
Physician Groups LC		Current since May 1, 2025	Accepting new patients
Total Access Urgent Care, PC		Current since Feb 7, 2020	Accepting new patients

Locations

2630 Highway K
O Fallon, MO 63368
Phone (636) 240-5454

9556 Manchester Rd
Saint Louis, MO 63119
Phone (314) 373-5740

1717 Madison Ave
Washington, MO 63090
Phone (636) 244-6950

13861 Manchester Rd
Wildwood, MO 63011
Phone (636) 220-9333

6215 Humphreys Blvd
Ste 201
Memphis, TN 38120
Phone (901) 866-8085

877 Jefferson Ave
Memphis, TN 38103
Phone (901) 448-5893

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Nurse Practitioner	363L00000X	2019033706	MO	Yes
Family Nurse Practitioner	363LF0000X	2019033706	MO

Addresses

Primary practice location

2630 State Highway K
Ofallon, MO 63368

Mailing address

PO Box 959354
Saint Louis, MO 63195-9354
Phone (636) 980-5300

Other practice location 1

9556 Manchester Rd
Saint Louis, MO 63119-1313
Phone (314) 373-5740

Electronic endpoints

Type	Endpoint	Use	Affiliation
FHIR URL	https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/	Health Information Exchange (HIE)

Other providers in Ofallon, MO

All providers in Ofallon, MO · Nurse Practitioner in Missouri

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 18, 2025. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
Medicare Care Compare provider data (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.