DR. MARK STANLEY WASSERMAN (MD) – Obstetrics & Gynecology Physician, NPI 1225130933
Obstetrics & Gynecology Physician
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Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
928 OBSTETRICS/GYNECOLOGY in MO
Provider Addresses for DR. MARK STANLEY WASSERMAN (MD)
965 MATTOX DR
SULLIVAN, MO 630802365
Phone: (573) 860-6000
Fax: (573) 860-6016
Type: Location
2100 Madison Ave
Granite City, IL 620404701
Phone: (618) 451-4872
Fax: (618) 451-6203
Type: Location
1103 W Liberty St
Farmington, MO 636401921
Phone: (573) 701-7227
Type: Location
Gateway Regional Medical Center, 2100, Madison Avenue, Granite City, Madison County, Illinois, 62040, United States
GRANITE CITY, IL 620404701
Phone: (618) 451-4872
Fax: (618) 451-6203
Type: Mailing
PO BOX 959318
SAINT LOUIS, MO 631959318
Phone: (573) 756-6751
Fax: (573) 756-6807
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 2 Open Payments records for all available years, with a total value of $34.
Total Amount is formed as General ($34) + Research ($0) + Ownership ($0) = $34.
Last reported payment date: 2024-08-27 • Largest payer in this snapshot: Lilly USA, LLC ($18).
Total Amount
$34
General + Research + Ownership
Payments
2
Total payment records
General Amount
$34
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-08-27
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Lilly USA, LLC | $18 |
| Sumitomo Pharma America, Inc. | $16 |
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: 2023-04-24
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 3 Medicare enrollment records; no due dates published yet.
Enrollment records
3
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 |
|---|---|---|---|---|
| I20040506001315 | I | Obstetrics/Gynecology | IL | TBD |
| I20211222000298 | I | Obstetrics/Gynecology | MO | TBD |
| I20230424001015 | I | Obstetrics/Gynecology | AZ | 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 63080)
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