DR. MARY BETH SUMMERVILLE PH.D.
NPI 1508946195
Psychologist - Clinical in Town And Country, MO

Q: What is Mary Summerville's NPI number?

The NPI number for Mary Summerville is 1508946195. It was assigned to this individual provider in the NPPES registry on October 17, 2006.

Q: What is Mary Summerville's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Q: When was this NPI record last updated?

The NPPES record for Mary Summerville was last updated on January 29, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 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.

Active since October 17, 2006PECOS EnrolledAccepts Medicare Assignment

425 S WOODS MILL RD STE 150, TOWN AND COUNTRY, MO 63017(636) 939-2550(314) 627-4978 Get Directions Write a Review

NPPES record last updated: January 29, 2026. Verified against the NPPES registry weekly; last sync: November 01, 2026.

On this page

About Dr. Mary Beth Summerville Ph.d. NPPES

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

DR. MARY BETH SUMMERVILLE PH.D. (NPI 1508946195) is an individual clinical provider in Town And Country, Missouri, licensed in Missouri (2018043945) and active in the NPI registry since October 2006. She is enrolled in Medicare PECOS and is a graduate of Other (1989).

NPPES Registry Identity

NPI1508946195

Entity TypeIndividualFemale

Primary Taxonomy103TC0700X

Provider Legal NameDR. MARY BETH SUMMERVILLECredential: PH.D.

Location Address425 S WOODS MILL RD STE 150Town And Country, MO 63017-9528

Mailing Address425 S Woods Mill Rd Ste 150Town And Country, MO 63017-9528 · (636) 939-2550 · Fax (314) 627-4978

Phone(636) 939-2550

Fax(314) 627-4978

Sole ProprietorYes

Medical School CMSOtherGraduated 1989

Enumeration DateOctober 17, 2006

Last NPPES UpdateJanuary 29, 2026

NPPES CertifiedJanuary 29, 2026

✔ NPI 1508946195 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

License✔ Licensed in MO · 2018043945

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

425 S WOODS MILL RD STE 150, Town And Country, MO 63017

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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Medica, UnitedHealthcare.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Mary Beth Summerville Ph.d. 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 ID4981625837

PECOS Enrollment IDI20220104000308

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 Mary Summerville reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Affinia Healthcare

16 mi

Federally Qualified Health Center (FQHC)

3930 S BROADWAY
Saint Louis, MO 63118

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

NPI 1013925890 (314) 577-6232

Psychological & Behavioral Consultants, LLC

515 mi

Psychiatry

25101 CHAGRIN BLVD STE 100
Beachwood, OH 44122

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

NPI 1811915713 (216) 468-5000

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 63017 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

$169.38 typical visit price

range $55.65 – $169.38

Typical copayment $42.34 (range $13.91 – $42.34)

Most-billed visit code 99205

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 11

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

ELIZABETH ANN GARCIA-REA PH.D.

Psychologist (Clinical)

425 S WOODS MILL RD STE 150
TOWN AND COUNTRY, MO 63017

St. Louis County (888) 356-1865

ALICIA ARENS LPC

Counselor (Professional)

425 S WOODS MILL RD STE 150
TOWN AND COUNTRY, MO 63017

St. Louis County (636) 939-2550

MRS. ANNA HIEN TRAN PMHNP-BC

Nurse Practitioner (Psychiatric/Mental Health)

425 S WOODS MILL RD STE 150
CHESTERFIELD, MO 63017

St. Louis County (636) 939-2550

ELIZABETH ANN BERRY PMHNP

Nurse Practitioner (Psychiatric/Mental Health)

425 S WOODS MILL RD STE 150
TOWN AND COUNTRY, MO 63017

St. Louis County (314) 269-0335

DR. AUDREY STUTSMAN PSYD

Psychologist (Clinical)

425 S WOODS MILL RD STE 150
TOWN AND COUNTRY, MO 63017

St. Louis County (314) 269-0335

TIMOTHY LAUGHTER LPC

Counselor (Professional)

425 S WOODS MILL RD STE 150
TOWN AND COUNTRY, MO 63017

St. Louis County (636) 939-2550

JASMINE BROWN MSW, LCSW

Social Worker (Clinical)

425 S WOODS MILL RD STE 150
TOWN AND COUNTRY, MO 63017

St. Louis County (636) 896-5366

JULIA JACOBS LCPC

Counselor (Professional)

425 S WOODS MILL RD STE 150
TOWN AND COUNTRY, MO 63017

St. Louis County (314) 269-0335

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 Mary Summerville's NPI number?

The NPI number for Mary Summerville is 1508946195. It was assigned to this individual provider in the NPPES registry on October 17, 2006.

Where is Mary Summerville located?

Mary Summerville practices at 425 S Woods Mill Rd Ste 150, Town And Country, MO 63017. The listed phone number is (636) 939-2550.

What is Mary Summerville's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Is Mary Summerville enrolled in Medicare?

Yes. Mary Summerville 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.

Which organizations bill Medicare for Mary Summerville's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Mary Summerville reassigns Medicare benefits to 2 organizations: Affinia Healthcare (Saint Louis, MO) and Psychological & Behavioral Consultants, LLC (Beachwood, OH). 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 Mary Summerville's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Mary Summerville accept?

Health plans from Anthem Blue Cross and Blue Shield, Medica and UnitedHealthcare list Mary Summerville as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Mary Summerville was last updated on January 29, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 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.