MS. MANDY ELIZABETH BETTENHAUSEN AGNP
NPI 1295254266
Nurse Practitioner - Gerontology in Saint Louis, MO

Q: What is Mandy Bettenhausen's NPI number?

The NPI number for Mandy Bettenhausen is 1295254266. It was assigned to this individual provider in the NPPES registry on September 11, 2017.

Q: What is Mandy Bettenhausen's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Gerontology, with taxonomy code 363LG0600X.

Active since September 11, 2017PECOS Enrolled

4901 FOREST PARK AVE, DIV SURG ACCS, STE 340, SAINT LOUIS, MO 63108(314) 362-5298(888) 824-2176 Get Directions Write a Review

NPPES record last updated: August 23, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Aug 23, 2023, Apr 11, 2023, May 18, 2022 and 3 more (6 updates tracked since 2017).

On this page

About Ms. Mandy Elizabeth Bettenhausen Agnp NPPES

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

MS. MANDY ELIZABETH BETTENHAUSEN AGNP (NPI 1295254266) is an individual gerontology provider in Saint Louis, Missouri, licensed in Missouri (2019008105) and active in the NPI registry since September 2017. She is enrolled in Medicare PECOS and is a graduate of Other (2018).

NPPES Registry Identity

NPI1295254266

Entity TypeIndividualFemale

Primary Taxonomy363LG0600X

Provider Legal NameMS. MANDY ELIZABETH BETTENHAUSENCredential: AGNP

Location Address4901 FOREST PARK AVE, DIV SURG ACCS, STE 340Saint Louis, MO 63108-1495

Mailing Address660 S Euclid Ave, Msc 8109-43-1160Saint Louis, MO 63110-1010 · (314) 362-5298 · Fax (888) 824-2176

Phone(314) 362-5298

Fax(888) 824-2176

Sole ProprietorNo

Medical School CMSOtherGraduated 2018

Enumeration DateSeptember 11, 2017

Last NPPES UpdateAugust 23, 20236 updates tracked since enumeration

NPPES CertifiedMay 18, 2022

✔ NPI 1295254266 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · GerontologyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LG0600X

License✔ Licensed in MO · 2019008105

4901 FOREST PARK AVE, Saint Louis, MO 63108

Open in Google Maps ↗

Other Identifiers 1

Medicaid420103116MO

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ms. Mandy Elizabeth Bettenhausen Agnp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID5294123212

PECOS Enrollment IDI20211119001208

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.

Medicare Billing Reassignments

Medicare enrollment records show Mandy Bettenhausen reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Washington University

0.4 mi

Multi-Specialty

660 S EUCLID AVE
Saint Louis, MO 63110

Reassigned Medicare billing, Missouri enrollment
172 clinicians in this Medicare group

NPI 1134169568 (314) 362-4964

Slh Physicians LLC

1.7 mi

Emergency Medicine

3635 VISTA AVE
Saint Louis, MO 63110

Reassigned Medicare billing, Missouri enrollment
194 clinicians in this Medicare group

NPI 1881668051 (314) 577-8000

Urology Of St. Louis, Inc.

6.5 mi

Specialist

12855 N 40 DR STE 375
Saint Louis, MO 63141

Reassigned Medicare billing, Illinois enrollment
55 clinicians in this Medicare group

NPI 1528017191 (314) 567-6071

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 63108 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 20

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

DR. ERIN LEIGH DYER MD

General Practice

4901 FOREST PARK AVE, DIV IM GENERAL MED, STE 241
SAINT LOUIS, MO 63108

St. Louis City (314) 362-5060

DR. NICHOLE GALLEGOS ZEHNDER MD

General Practice

4901 FOREST PARK AVE, DIV IM GENERAL MED, STE 241
SAINT LOUIS, MO 63108

St. Louis City (314) 362-5060

MRS. NANCY J CIBULKA WHNP

Nurse Practitioner (Family)

4901 FOREST PARK AVE, STE 341
SAINT LOUIS, MO 63108

St. Louis City (314) 454-7882

DR. MARCIA J MCCABE PSYD

Psychologist

4901 FOREST PARK AVE, DEPT PSYCHIATRY, STE 441
SAINT LOUIS, MO 63108

St. Louis City (314) 286-1700

WASHINGTON UNIVERSITY

Clinic/Center (Multi-Specialty)

4901 FOREST PARK AVE
SAINT LOUIS, MO 63108

St. Louis City (314) 362-3937

DR. JING-WEI HUANG MD

Ophthalmology (Cornea and External Diseases Specialist)

4901 FOREST PARK AVE, DEPT OPHTHALMOLOGY, 6TH FL
SAINT LOUIS, MO 63108

St. Louis City (314) 362-3937

DR. DAVID L EISENBERG MD

Obstetrics & Gynecology (Gynecology)

4901 FOREST PARK AVE, DIV OBGYN FAMILY PLANNING, STE 710
SAINT LOUIS, MO 63108

St. Louis City (314) 362-4211

NICHOLAS RICHARD LEVERGOOD MD

Ophthalmology (Ophthalmic Plastic and Reconstructive Surgery)

4901 FOREST PARK AVE, DEPT OPHTHALMOLOGY, 6TH FL
SAINT LOUIS, MO 63108

St. Louis City (314) 362-3937

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 Mandy Bettenhausen's NPI number?

The NPI number for Mandy Bettenhausen is 1295254266. It was assigned to this individual provider in the NPPES registry on September 11, 2017.

Where is Mandy Bettenhausen located?

Mandy Bettenhausen practices at 4901 Forest Park Ave Div Surg Accs, Ste 340, Saint Louis, MO 63108. The listed phone number is (314) 362-5298.

What is Mandy Bettenhausen's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Gerontology, with taxonomy code 363LG0600X.

Is Mandy Bettenhausen enrolled in Medicare?

Yes. Mandy Bettenhausen is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Mandy Bettenhausen's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Mandy Bettenhausen reassigns Medicare benefits to 3 organizations: Washington University (Saint Louis, MO), Slh Physicians LLC (Saint Louis, MO) and Urology Of St. Louis, Inc. (Saint Louis, MO). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Mandy Bettenhausen's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Mandy Bettenhausen was last updated on August 23, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years 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.