DIANE M PETERSEN (M.D.) – Obstetrics & Gynecology Physician, NPI 1790719342
Obstetrics & Gynecology Physician
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Profile Insights
NPPES metrics only — not quality of care.
929 OBSTETRICS/GYNECOLOGY in MO
Provider Addresses for DIANE M PETERSEN (M.D.)
615 S New Ballas Rd
Saint Louis, MO 631418221
Phone: (314) 251-7498
Type: Location
SSM Health St. Mary's Hospital: Hospital Building, 6420, Clayton Road, Hi-Pointe, Richmond Heights, Saint Louis County, Missouri, 63117, United States
SUITE 290
SAINT LOUIS, MO 631171811
Phone: (314) 781-1505
Fax: (314) 781-2840
Type: Mailing
1031 Medical Building, 1031, Bellevue Avenue, Richmond Heights, Saint Louis County, Missouri, 63117, United States
SUITE 400
SAINT LOUIS, MO 631171818
Phone: (314) 977-7455
Fax: (314) 977-7477
Type: Location
10010 KENNERLY RD FL 4
SAINT LOUIS, MO 631282106
Phone: (314) 525-6072
Fax: (314) 525-1387
Type: Mailing
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: 2004-11-10
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
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 |
|---|---|---|---|---|
| I20041110000133 | I | Obstetrics/Gynecology | 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 63141)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| OBSTETRICS/GYNECOLOGY | MO | 76830 | Ultrasound pelvis through vagina | 14 | 14 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| - | MO | |
| Internal Medicine | MO | |
| Nurse Practitioner | MO | |
| - | MO | |
| - | IL | |
| - | MO | |
| O B S T E T R I C S/ G Y N E C O L O G Y | MO | |
| Physical Medicine And Rehabilitation | MO | |
| - | MO | |
| Nurse Practitioner | MO |
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