ST. LOUIS NEPHROLOGY AND HYPERTENSION – Nephrology Physician, NPI 1174601124
Nephrology Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for ST. LOUIS NEPHROLOGY AND HYPERTENSION
1034, South Brentwood Boulevard, Richmond Heights, Saint Louis County, Missouri, 63117, United States
STE 1280
SAINT LOUIS, MO 631171223
Phone: (314) 644-3535
Fax: (314) 644-3255
Type: Location
9 American Vlg
Granite City, IL 620403706
Phone: (618) 452-5858
Type: Location
101 Lanter Ct
Collinsville, IL 622346124
Phone: (618) 344-2080
Type: Location
PO BOX 797021
SAINT LOUIS, MO 631797000
Phone: (314) 644-3535
Type: Mailing
2102 VADALABENE DR
MARYVILLE, IL 620625632
Phone: (618) 288-1196
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: 2008-01-10
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2024-09-30 (618 days ago).
Enrollment records
2
Earliest due date
2024-09-30
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 |
|---|---|---|---|---|
| O20071215000127 | O | Clinic/Group Practice | IL | 2025-07-31 |
| O20080110000678 | O | Clinic/Group Practice | MO | 2024-09-30 |
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 63117)
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