ST LOUIS KIDNEY CARE LLC – Nephrology Physician, NPI 1780058727
Nephrology Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for ST LOUIS KIDNEY CARE LLC
11155 DUNN RD STE 211N
SAINT LOUIS, MO 631366166
Phone: (314) 741-1600
Fax: (314) 741-1677
Type: Mailing
1265 GRAHAM RD STE 1
FLORISSANT, MO 630318018
Phone: (314) 741-1600
Fax: (314) 741-1677
Type: Mailing
1400 US Highway 61 Ste 240A
Festus, MO 630284141
Phone: (636) 937-3337
Fax: (636) 931-7671
Type: Location
2044 Madison Ave Ste 15
Granite City, IL 620404641
Phone: (314) 741-1600
Fax: (314) 741-1677
Type: Location
2 Memorial Dr Ste 201
Alton, IL 620026723
Phone: (314) 741-1600
Fax: (314) 741-1677
Type: Location
55 Nesbit Dr Ste B
Bonne Terre, MO 636281353
Phone: (636) 937-3337
Fax: (636) 931-7671
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: 2017-01-30
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2023-08-31 (1014 days ago).
Enrollment records
2
Earliest due date
2023-08-31
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 |
|---|---|---|---|---|
| O20160809001801 | O | Clinic/Group Practice | MO | 2023-08-31 |
| O20170130000907 | O | Clinic/Group Practice | IL | TBD |
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 63136)
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