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MARY DEANE KITCHURA PA
NPI 1538056148
Physician Assistant in Ballwin, MO

Active since June 18, 2025PECOS Enrolled
15945 CLAYTON RD STE 120A, BALLWIN, MO 63011(636) 256-5000(636) 256-5100 Get Directions Write a Review

NPPES record last updated: October 3, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Mary Deane Kitchura Pa NPPES

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

MARY DEANE KITCHURA PA (NPI 1538056148) is an individual physician assistant in Ballwin, Missouri, licensed in Missouri (2025040004) and active in the NPI registry since June 2025. She is enrolled in Medicare PECOS and is a graduate of Other (2025).

NPPES Registry Identity

NPI1538056148
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameMARY DEANE KITCHURACredential: PA
Location Address15945 CLAYTON RD STE 120ABallwin, MO 63011-2490
Mailing Address920 Rocky Cove DrLabadie, MO 63055-1988 · (314) 365-4767
Phone(636) 256-5000
Fax(636) 256-5100
Sole ProprietorNo
Medical School CMSOtherGraduated 2025
Enumeration DateJune 18, 2025
Last NPPES UpdateOctober 3, 2025
NPPES CertifiedOctober 3, 2025
✔ NPI 1538056148 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in MO · 2025040004
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
15945 CLAYTON RD STE 120A, Ballwin, MO 63011
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mary Deane Kitchura Pa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID1759878465
PECOS Enrollment IDI20251016000532
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 63011 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
$69.50 typical visit price
range $17.76 – $137.92
Typical copayment $17.37 (range $4.44 – $34.48)
Most-billed visit code 99213
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.

SUSAN M SULLIVAN FNP
Nurse Practitioner (Adult Health)
15945 CLAYTON RD STE 120A
BALLWIN, MO 63011
St. Louis County (636) 256-5000
BEVERLY ANN WILHELM-ONEY MD
Surgery
15945 CLAYTON RD STE 120A
BALLWIN, MO 63011
St. Louis County (636) 256-5000

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 Kitchura's NPI number?

The NPI number for Mary Kitchura is 1538056148. It was assigned to this individual provider in the NPPES registry on June 18, 2025.

Where is Mary Kitchura located?

Mary Kitchura practices at 15945 Clayton Rd Ste 120A, Ballwin, MO 63011. The listed phone number is (636) 256-5000.

What is Mary Kitchura's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Mary Kitchura enrolled in Medicare?

Yes. Mary Kitchura is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Mary Kitchura was last updated on October 3, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.