Cassidy Victoria Bellville, APRN
Individual provider Active NPI Nurse Practitioner · Sullivan, MO
NPI 1982495487 · NPPES record last updated Sep 16, 2025
Key facts
- NPI
- 1982495487
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 2025017389 (MO)
- Practice address
- 751 Sappington Bridge Rd
Sullivan, MO 63080-2354 - Phone
- (573) 468-4186
- NPI assigned
- May 14, 2025
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 9
Hospital & facility affiliations 7
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2025
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Missouri Baptist Hospital of Sullivan
Practice addresses (Care Compare)
751 Sappington Bridge Rd
Sullivan, MO 63080-2354
Phone (573) 468-4186
Hospital & facility affiliations
- Missouri Baptist Sullivan Hospital
- Phelps County Regional Medical Center
- Parkland Health Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in 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 |
|---|---|---|---|---|
| I20250902002283 | MO | Practitioner - Nurse Practitioner | 2466953278 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2025017389 | MO | MD | Nurse Practitioner |
| AG0520031 | MO | MD | Gerontology Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Missouri Baptist Hospital of Sullivan | Current | Accepting new patients | |
| Missouri Baptist Hospital of Sullivan | Current |
Accepting new patients | |
| Missouri Baptist Hospital of Sullivan | Current |
Accepting new patients |
Locations
751 Sappington Bridge Rd
Sullivan, MO 63080
Phone (573) 468-1343
965 Mattox Dr
Sullivan, MO 63080
Phone (573) 468-7054
Interoperability endpoints
- https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gerontology Nurse Practitioner | 363LG0600X | AG0520031 | MO | |
| Adult Health Nurse Practitioner | 363LA2200X | AG0520031 | MO | |
| Nurse Practitioner | 363L00000X | 2025017389 | MO | Yes |
Addresses
Primary practice location
751 Sappington Bridge Rd
Sullivan, MO 63080-2354
Mailing address
PO Box 959318
Saint Louis, MO 63195-9318
Phone (573) 468-4186
Other practice location 1
29 High Trails Dr
Eureka, MO 63025-3518
Phone (918) 361-6113
Other names
- Cassidy Victoria Bellville
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| FHIR URL | https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2 | Health Information Exchange (HIE) |
NPI Registry JSON
{
"created_epoch": "1747180800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757980800000",
"number": "1982495487",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 959318",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631959318",
"telephone_number": "573-468-4186",
"fax_number": "573-860-6179"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "751 SAPPINGTON BRIDGE RD",
"city": "SULLIVAN",
"state": "MO",
"postal_code": "630802354",
"telephone_number": "573-468-4186"
}
],
"practiceLocations": [
{
"address_1": "29 High Trails Dr",
"address_purpose": "LOCATION",
"city": "Eureka",
"state": "MO",
"postal_code": "630253518",
"country_code": "US",
"telephone_number": "918-361-6113",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BELLVILLE",
"first_name": "CASSIDY",
"middle_name": "VICTORIA",
"credential": "APRN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-05-14",
"last_updated": "2025-09-16",
"certification_date": "2025-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "363LG0600X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Gerontology",
"state": "MO",
"license": "AG0520031",
"primary": false
},
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "MO",
"license": "AG0520031",
"primary": false
},
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MO",
"license": "2025017389",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2",
"affiliation": "N",
"endpointDescription": "BJC",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "751 Sappington Bridge Rd",
"city": "Sullivan",
"state": "MO",
"country_code": "US",
"postal_code": "630802354",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"first_name": "CASSIDY",
"last_name": "BELLVILLE",
"middle_name": "VICTORIA",
"credential": "APRN",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Sullivan, MO
- BC Missouri Emergency Physicians, LLP
- Danielle Bealmear
- Aleta Diane Beaty
- Katherine M Beckett
- Bel Oak of Meramec LLC
- Bio-Medical Applications of Missouri, Inc.
- Mary J Bjornstad
- Sadie Blankenship
- Barbara L Blaue
- Catherine Marie Blunda
All providers in Sullivan, 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 16, 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.