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EBONY CASSANDRA SUDDUTH DNP, PMHNP-BC
NPI 1174497721
Nurse Practitioner - Psychiatric/Mental Health in Saint Louis, MO

Active since October 06, 2025PECOS EnrolledAccepts Medicare Assignment
3824 S GRAND BLVD, SAINT LOUIS, MO 63118(314) 814-8180 Get Directions Write a Review

NPPES record last updated: March 16, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Mar 16, 2026, Oct 6, 2025 (2 updates tracked since 2025).

About Ebony Cassandra Sudduth Dnp, Pmhnp-bc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EBONY CASSANDRA SUDDUTH DNP, PMHNP-BC (NPI 1174497721) is an individual psychiatric/mental health provider in Saint Louis, Missouri, licensed in Missouri (2025041043) and active in the NPI registry since October 2025. She is enrolled in Medicare PECOS, maintains 2 additional practice locations, and is a graduate of Other (2025).

NPPES Registry Identity

NPI1174497721
Entity TypeIndividualFemale
Primary Taxonomy363LP0808X
Provider Legal NameEBONY CASSANDRA SUDDUTHCredential: DNP, PMHNP-BC
Location Address3824 S GRAND BLVDSaint Louis, MO 63118-3412
Mailing Address10200 Cedarhurst DrSaint Louis, MO 63136-5616 · (636) 628-5801
Phone(314) 814-8180
Sole ProprietorNo
Medical School CMSOtherGraduated 2025
Enumeration DateOctober 6, 2025
Last NPPES UpdateMarch 16, 20262 updates tracked since enumeration
NPPES CertifiedMarch 16, 2026
✔ NPI 1174497721 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
License✔ Licensed in MO · 2025041043
3824 S GRAND BLVD, Saint Louis, MO 63118
Open in Google Maps ↗

Secondary Practice Locations 2

Location 14352 Manchester AveSaint Louis, MO 63110-2138 · Phone (314) 531-5444 · Fax (314) 531-0063
Location 2401 Holly Hills AveSaint Louis, MO 63111-2410 · Phone (314) 353-5190 · Fax (314) 353-7631

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Ebony Cassandra Sudduth Dnp, Pmhnp-bc is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID42707820
PECOS Enrollment IDI20251015001385
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 63118 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$86.32 typical visit price
range $55.65 – $169.38
Typical copayment $21.58 (range $13.91 – $42.34)
Most-billed visit code 99203
Established Patient
$98.37 typical visit price
range $17.76 – $137.92
Typical copayment $24.59 (range $4.44 – $34.48)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

FAMILY CARE HEALTH CENTERS
Clinic/Center (Federally Qualified Health Center (FQHC))
3824 S GRAND BLVD
SAINT LOUIS, MO 63118
St. Louis City (314) 678-2451
FAMILY CARE HEALTH CENTERS
Pharmacy
3824 S GRAND BLVD
SAINT LOUIS, MO 63118
St. Louis City (314) 481-1615

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ebony Sudduth's NPI number?

The NPI number for Ebony Sudduth is 1174497721. It was assigned to this individual provider in the NPPES registry on October 6, 2025.

Where is Ebony Sudduth located?

Ebony Sudduth practices at 3824 S Grand Blvd, Saint Louis, MO 63118. The listed phone number is (314) 814-8180.

What is Ebony Sudduth's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Is Ebony Sudduth enrolled in Medicare?

Yes. Ebony Sudduth is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Ebony Sudduth was last updated on March 16, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.