ANNE MARIE BRIDEGROOM (PA) – Physician Assistant, NPI 1811262694

ANNE MARIE BRIDEGROOM (PA) is a healthcare provider. based in Granite city, Illinois. specializing in PHYSICIAN ASSISTANT. They hold the professional credentials PA. They hold a License No. 2021004987 (MO). The NPI Number for ANNE MARIE BRIDEGROOM (PA) is 1811262694

Main info

Female
15 Years Of Experience
Accepts Medicare Assignment
Name
ANNE MARIE BRIDEGROOM (PA)
NPI
1811262694
Phone
(314) 830-2600
Address
2421 Corporate Ctr Ste 105
Enumeration Date
13 March 2012
Last Update Date
9 February 2026

Doctor Profile

Medical School Name
UNIVERSITY OF SOUTH ALABAMA COLLEGE OF MEDICINE
Secondary Phone
3148302600
Graduation Year
2011 (15 years ago)
PAC ID
1052574902
Group Practice PAC ID
3779532858
Professional Enrollment ID
I20221004000959
Address ID
MO633035677SA2730XPKWY503
Telehealth
Yes
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience66
Completeness85
Years active:14State licenses:2Digital endpointsOther names

5,035 PHYSICIAN ASSISTANT in IL

Provider Addresses for ANNE MARIE BRIDEGROOM (PA)

  • 2421 Corporate Ctr Ste 105

    Granite City, IL 620404195

    Phone: (314) 830-2600

    Fax: (314) 830-2648

    Type: Location

  • 5023 W 120TH AVE STE 312

    BROOMFIELD, CO 800205606

    Phone: (720) 644-9355

    Type: Mailing

  • 12230 LIONESS WAY

    PARKER, CO 80134

    Phone: (720) 644-9355

    Type: Location

  • PO BOX 650

    EDWARDSVILLE, IL 620250650

    Phone: (314) 830-2600

    Fax: (314) 830-2648

    Type: Mailing

  • 261 DUNN RD

    FLORISSANT, MO 630317928

    Phone: (314) 830-2600

    Fax: (314) 830-2648

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 58 Open Payments records for all available years, with a total value of $787.

Total Amount is formed as General ($787) + Research ($0) + Ownership ($0) = $787.

Last reported payment date: 2024-12-23 • Largest payer in this snapshot: Salix Pharmaceuticals, a division of Bausch Health US, LLC ($652).

Total Amount

$787

General + Research + Ownership

Payments

58

Total payment records

General Amount

$787

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-12-23

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

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: 2022-10-04

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

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20120514000219IPhysician AssistantSCTBD
I20221004000959IPhysician AssistantMOTBD

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.

Verify on CMS Revalidation Lookup Tool

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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99213Established patient office or other outpatient visit, 20-29 minutes382135$0
99214Established patient office or other outpatient visit, 30-39 minutes13885$0
80307Testing for presence of drug, by chemistry analyzers1212$0
G0482Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms1212$0
View full utilization report →

Insurance plans in this area (ZIP 62040)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 3779532858View full group profile
NameSpecialtyState
Nurse PractitionerIL
Nurse PractitionerIL
Physical Medicine And Rehabilitation, Pain ManagementIL

Reviews

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Frequently asked questions

What is ANNE MARIE BRIDEGROOM (PA)'s NPI number?
ANNE MARIE BRIDEGROOM (PA)'s NPI is 1811262694 — the number used across U.S. healthcare to identify this provider.
Would ANNE MARIE BRIDEGROOM (PA) appear as active to a payer?
You can treat ANNE MARIE BRIDEGROOM (PA) as active for directory purposes; confirm clinical privileges separately.
What expertise is attributed to ANNE MARIE BRIDEGROOM (PA)?
ANNE MARIE BRIDEGROOM (PA)'s specialty line reads Physician Assistant. Clinical services aligned with this taxonomy classification.
Is ANNE MARIE BRIDEGROOM (PA) located near Granite City?
ANNE MARIE BRIDEGROOM (PA) currently maps to Granite City, Illinois in this extract.
When was this NPI issued?
Enumeration for ANNE MARIE BRIDEGROOM (PA) is noted as March 13, 2012 where the registry provides it.

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