SSM Health St Clare Fenton – Emergency Medicine Physician, NPI 1275586174
Emergency Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for SSM Health St Clare Fenton
1011 Bowles Ave
Fenton, MO 630262395
Phone: (557) 203-1486
Fax: (314) 344-7239
Type: Location
1296 Jeffco Blvd Ste B
Arnold, MO 630102138
Phone: (636) 321-8604
Fax: (314) 344-7281
Type: Location
SSM St. Clare Health Center, 1015, Bowles Avenue, Fenton, Saint Louis County, Missouri, 63026, United States
FENTON, MO 63026
Phone: (636) 496-2502
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) 344-7281
Type: Mailing
12800 CORPORATE HILL DR
SAINT LOUIS, MO 631311833
Phone: (557) 203-1486
Fax: (314) 344-7239
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: 2025-10-24
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 |
|---|---|---|---|---|
| O20251024002672 | O | Clinic/Group Practice | IL | 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 63026)
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