Chesterfield Bariatric Surgery – Surgery Physician, NPI 1396288106
Surgery Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Chesterfield Bariatric Surgery
PO BOX 66738 # 19038
ST LOUIS, MO 63166
Phone:
Type: Mailing
432, North Pleasant Avenue, Centralia, Marion County, Illinois, 62801, United States
CENTRALIA, IL 628013006
Phone: (636) 224-6646
Type: Location
16216 Baxter Rd Ste 110
Chesterfield, MO 630174778
Phone: (314) 500-2424
Fax: (682) 334-7213
Type: Location
10004 KENNERLY RD STE 295B
SAINT LOUIS, MO 631282177
Phone: (314) 500-2424
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: 2024-08-09
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
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 |
|---|---|---|---|---|
| O20170124000170 | O | Clinic/Group Practice | IL | TBD |
| O20240809001979 | O | Clinic/Group Practice | MO | 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 63166)
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