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DR. JEREMY RUCKSTAETTER PHD, LPC, NCC
NPI 1851916043
Counselor - Professional in Saint Louis, MO

Active since June 12, 2020Opted out of Medicare · through Dec 4, 2027
1023 EXECUTIVE PARKWAY DR STE 10, SAINT LOUIS, MO 63141(314) 469-5522 Get Directions Write a Review

NPPES record last updated: June 12, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Dr. Jeremy Ruckstaetter Phd, Lpc, Ncc NPPES

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

DR. JEREMY RUCKSTAETTER PHD, LPC, NCC (NPI 1851916043) is an individual professional provider in Saint Louis, Missouri, licensed in Missouri (2011033777) and active in the NPI registry since June 2020. He has opted out of Medicare through December 4, 2027.

NPPES Registry Identity

NPI1851916043
Entity TypeIndividualMale
Primary Taxonomy101YP2500X
Provider Legal NameDR. JEREMY RUCKSTAETTERCredential: PHD, LPC, NCC
Location Address1023 EXECUTIVE PARKWAY DR STE 10Saint Louis, MO 63141-6323
Mailing Address15638 Summer Lake DrChesterfield, MO 63017-5136
Phone(314) 469-5522
Sole ProprietorNo
Enumeration DateJune 12, 2020
NPPES CertifiedJune 12, 2020
✔ NPI 1851916043 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers
Taxonomy Code101YP2500X
License✔ Licensed in MO · 2011033777
1023 EXECUTIVE PARKWAY DR STE 10, Saint Louis, MO 63141
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Jeremy Ruckstaetter Phd, Lpc, Ncc has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from December 4, 2025 through December 4, 2027.

Opt-Out Effective DateDecember 4, 2025
Opt-Out In Effect ThroughDecember 4, 2027Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Other Providers at the Same Location NPPES 10

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

LILIAN M WERNER MAC, LPC
Counselor
1023 EXECUTIVE PARKWAY DR STE 10
SAINT LOUIS, MO 63141
St. Louis County (314) 469-5522
SARA KAY COKER
Counselor (Mental Health)
1023 EXECUTIVE PARKWAY DR STE 10
SAINT LOUIS, MO 63141
St. Louis County (314) 469-5522
JOEL CHAPPEAU MAC, LPC
Counselor (Professional)
1023 EXECUTIVE PARKWAY DR STE 10
SAINT LOUIS, MO 63141
St. Louis County (314) 469-5522
TRACIE WALLACE LPC
Counselor (Professional)
1023 EXECUTIVE PARKWAY DR STE 10
SAINT LOUIS, MO 63141
St. Louis County (314) 469-5522
DORINDA PEYTON LPC
Counselor (Professional)
1023 EXECUTIVE PARKWAY DR STE 10
SAINT LOUIS, MO 63141
St. Louis County (314) 469-5522
GINA MARIE BIRKEMEIER
Counselor (Professional)
1023 EXECUTIVE PARKWAY DR STE 10
SAINT LOUIS, MO 63141
St. Louis County (314) 469-5522
MRS. PATRICIA A. ROOSEVELT LPC
Counselor (Professional)
1023 EXECUTIVE PARKWAY DR STE 10
SAINT LOUIS, MO 63141
St. Louis County (314) 469-5522
CHAD RICHARD FRIZZELL LPC
Counselor (Professional)
1023 EXECUTIVE PARKWAY DR STE 10
SAINT LOUIS, MO 63141
St. Louis County (314) 469-5522

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 Jeremy Ruckstaetter's NPI number?

The NPI number for Jeremy Ruckstaetter is 1851916043. It was assigned to this individual provider in the NPPES registry on June 12, 2020.

Where is Jeremy Ruckstaetter located?

Jeremy Ruckstaetter practices at 1023 Executive Parkway Dr Ste 10, Saint Louis, MO 63141. The listed phone number is (314) 469-5522.

What is Jeremy Ruckstaetter's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

Is Jeremy Ruckstaetter enrolled in Medicare?

No. Jeremy Ruckstaetter has opted out of Medicare through December 4, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Jeremy Ruckstaetter was last updated on June 12, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.