SSM Health Cardinal Glennon Children's Hospital – Pediatrics Physician, NPI 1174577670
Pediatrics Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for SSM Health Cardinal Glennon Children's Hospital
226 S Woods Mill Rd Ste 62W
Chesterfield, MO 630173665
Phone: (314) 469-3990
Fax: (314) 344-7281
Type: Location
13000 Butler Crest Dr
Saint Louis, MO 631284276
Phone: (314) 842-3535
Fax: (314) 344-7281
Type: Location
1465 S Grand Blvd
Saint Louis, MO 631041003
Phone: (314) 577-5600
Fax: (314) 268-6468
Type: Location
Corporate Lake Drive, 39 North, Creve Coeur, Saint Louis County, Missouri, 63132, United States
SAINT LOUIS, MO 631322907
Phone: (314) 989-6843
Fax: (314) 989-7281
Type: Mailing
HSHS Saint Elizabeth's Hospital, 1, Saint Elizabeth's Boulevard, Glenview, O'Fallon, Saint Clair County, Illinois, 62269, United States
O FALLON, IL 622691099
Phone: (618) 234-2120
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: 2003-12-31
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2024-02-29 (832 days ago).
Enrollment records
1
Earliest due date
2024-02-29
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 |
|---|---|---|---|---|
| O20170612002061 | O | Clinic/Group Practice | IL | 2024-02-29 |
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 63017)
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