TAYLOR RAE PARK (NP) – Nurse Practitioner, NPI 1780454389
Nurse Practitioner
Main info
Doctor Profile
Contacts
Profile Insights
NPPES metrics only — not quality of care.
7,017 NURSE PRACTITIONER in MO
Provider Addresses for TAYLOR RAE PARK (NP)
PO BOX 959354
SAINT LOUIS, MO 631959354
Phone: (314) 953-8271
Fax: (314) 953-8272
Type: Mailing
1225 GRAHAM RD STE C-1340
FLORISSANT, MO 630318019
Phone: (314) 953-8271
Type: Location
903 S State St
Jerseyville, IL 620522344
Phone: (618) 498-2273
Fax: (618) 639-8100
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2024-11-20
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20240404001891 | I | Nurse Practitioner | IL | TBD |
| I20241120001784 | I | Nurse Practitioner | MO | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 63195)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | IL | |
| Certified Registered Nurse Anesthetist (Crna) | IL | |
| - | NY | |
| Certified Registered Nurse Anesthetist (Crna) | IL | |
| Certified Registered Nurse Anesthetist (Crna) | IL | |
| Cardiovascular Disease (Cardiology) | MO | |
| G A S T R O E N T E R O L O G Y | MO | |
| - | NC | |
| - | IL | |
| Certified Registered Nurse Anesthetist (Crna) | IL |
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