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ST LOUIS DERMATOLOGY LLC
NPI 1760810543
Dermatology in Fenton, MO

Active since October 14, 2013
1011 BOWLES AVENUE, SUITE 121, FENTON, MO 63026(314) 200-2713(314) 200-2714 Get Directions Write a Review

NPPES record last updated: February 18, 2014. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About St Louis Dermatology Llc NPPES

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

ST LOUIS DERMATOLOGY LLC (NPI 1760810543) is a healthcare organization registered as a dermatology in Fenton, Missouri and active in the NPI registry since October 2013. The organization lists Jeffrey E Petersen, Owner, as its authorized official.

NPPES Registry Identity

NPI1760810543
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameST LOUIS DERMATOLOGY LLC
Location Address1011 BOWLES AVENUE, SUITE 121Fenton, MO 63026-2387
Mailing Address1011 Bowles Avenue, Suite 121Fenton, MO 63026-2387 · (314) 200-2713 · Fax (314) 200-2714
Phone(314) 200-2713
Fax(314) 200-2714
Organization SubpartNo
Authorized OfficialJeffrey E PetersenOwner · (314) 200-2713
Enumeration DateOctober 14, 2013
Last NPPES UpdateFebruary 18, 2014
✔ NPI 1760810543 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
License✔ Licensed in MO · 2001020599
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
1011 BOWLES AVENUE, Fenton, MO 63026
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Sunflower Health Plan, Ambetter Health and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

St Louis Dermatology Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

6

Medicare enrollment records show 6 clinicians reassign Medicare billing to St Louis Dermatology LLC, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.

Clinicians, nearest first (6)

Anastasia Averbukh, NP
Nurse Practitioner
NPI 1073903134
1011 BOWLES AVENUE SUITE 121
Fenton, MO 63026
(314) 200-2713
✔ PECOS✔ Accepts MedicareSame address
Jeffrey Petersen, MD
Dermatology
NPI 1275551707
1011 BOWLES AVE SUITE 121
Fenton, MO 63026
(314) 200-2713
✔ PECOS✔ Accepts MedicareSame address
Patrick Behnke, NP
Nurse Practitioner
NPI 1417490772
100 CHESTERFIELD BUSINESS PKWY STE 110
Chesterfield, MO 63005
(636) 532-0990
✔ PECOS✔ Accepts Medicare12 mi
Jessica Faron
Nurse Practitioner
NPI 1750841771
100 CHESTERFIELD BUSINESS PKWY STE 110
Chesterfield, MO 63005
(636) 532-0990
✔ PECOS✔ Accepts Medicare12 mi
Shivani Tripathi, MD
Dermatology
NPI 1447543475
4901 FOREST PARK AVE DIV IM DERMATOLOGY, STE 502
Saint Louis, MO 63108
(314) 273-3376
✔ PECOS✔ Accepts Medicare14 mi
Lindsey Graviett, M.D.
Dermatology
NPI 1235584822
1060 MEYER RD
Wentzville, MO 63385
(314) 230-1500
✔ PECOS✔ Accepts Medicare29 mi

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

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 St Louis Dermatology LLC's NPI number?

The NPI number for St Louis Dermatology LLC is 1760810543. It was assigned to this organization in the NPPES registry on October 14, 2013.

Where is St Louis Dermatology LLC located?

St Louis Dermatology LLC is located at 1011 Bowles Avenue Suite 121, Fenton, MO 63026. The listed phone number is (314) 200-2713.

What is St Louis Dermatology LLC's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Is St Louis Dermatology LLC enrolled in Medicare?

Yes. St Louis Dermatology LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through St Louis Dermatology LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 6 clinicians in 2 Medicare specialties reassign their Medicare billing to St Louis Dermatology LLC. A 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 the clinician's services. The largest specialties are Dermatology (3) and Nurse Practitioner (3). Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does St Louis Dermatology LLC accept?

Health plans from Ambetter Health, Ambetter Health of Delaware, Ambetter from Arkansas Health & Wellness, Ambetter from Sunflower Health Plan and Ambetter of Oklahoma and 3 other insurers list St Louis Dermatology LLC 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 St Louis Dermatology LLC was last updated on February 18, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 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.