SSM Health Cardinal Glennon Pediatrics – Pediatrics Physician, NPI 1073568226
Pediatrics Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for SSM Health Cardinal Glennon Pediatrics
4100 FOREST PARK AVE STE 101A
SAINT LOUIS, MO 631082885
Phone: (314) 577-5627
Fax: (314) 344-7281
Type: Location
12255 DePaul Drive Ste 300
Bridgeton, MO 630442512
Phone: (314) 344-6021
Type: Location
3878 Pershall Rd
Ferguson, MO 631351246
Phone: (314) 344-6021
Fax: (314) 344-7281
Type: Location
511 Ashland Ave Ste A
Warrenton, MO 633831065
Phone: (636) 456-0572
Type: Location
12303 De Paul Dr
Bridgeton, MO 630442512
Phone: (314) 344-6000
Fax: (314) 344-6840
Type: Location
132 Professional Pkwy
Troy, MO 633792823
Phone: (636) 462-5437
Type: Location
6800 State Route 162
Maryville, IL 620622512
Phone: (618) 288-5711
Type: Location
4129 North Highway 67
Florissant, MO 630342512
Phone: (314) 355-6390
Fax: (314) 355-2417
Type: Location
9553 Lackland Road
St.Louis, MO 631142512
Phone: (314) 429-7733
Fax: (314) 429-3194
Type: Location
1173 CORPORATE LAKE DR
SAINT LOUIS, MO 631321716
Phone: (314) 989-6843
Fax: (314) 344-7239
Type: Mailing
2927 S . KINGS HIGHWAY BLVD
SAINT LOUIS, MO 631391008
Phone: (314) 268-4070
Fax: (314) 268-4019
Type: Location
1145, Corporate Lake Drive, 39 North, Creve Coeur, Saint Louis County, Missouri, 63132, United States
SAINT LOUIS, MO 631322907
Phone: (314) 989-6843
Fax: (314) 344-7281
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: 2017-06-12
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2024-08-31 (650 days ago).
Enrollment records
1
Earliest due date
2024-08-31
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 |
|---|---|---|---|---|
| O20031231000604 | O | Clinic/Group Practice | MO | 2024-08-31 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
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 63108)
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