PRO PAIN LLC – Pain Medicine (Anesthesiology) Physician, NPI 1205339074
Pain Medicine (Anesthesiology) Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for PRO PAIN LLC
4800 Mexico Rd
Saint Peters, MO 63376
Phone: (636) 442-5036
Type: Location
Mexico Road, Saint Peters, Saint Charles County, Missouri, 63376, United States
SAINT PETERS, MO 633761666
Phone: (636) 442-5035
Type: Mailing
Bowles Avenue, Fenton, Saint Louis County, Missouri, 63026, United States
FENTON, MO 630262308
Phone: (636) 326-7821
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: 2019-01-30
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Revalidation scheduled
Earliest CMS due date is 2026-10-31 (143 days away).
Enrollment records
2
Earliest due date
2026-10-31
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 |
|---|---|---|---|---|
| O20180419001389 | O | Clinic/Group Practice | MO | TBD |
| O20190130000208 | O | Physician - Interventional Pain Management | MO | 2026-10-31 |
What to do next
- Monitor the published due date as it approaches.
- Plan to revalidate in PECOS within the window CMS allows before the due date.
- Verify the date on the CMS Revalidation Lookup Tool before submitting.
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 63376)
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