SSM CARDINAL GLENNON CHILDRENS HOSPITAL (NPI# 1174577670) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174577670 |
| Entity Type | Organization |
| Organization Name | SSM CARDINAL GLENNON CHILDRENS HOSPITAL |
| Other Organization Name | SSM HEALTH CARDINAL GLENNON CHILDREN'S HOSPITAL |
| Practice Address |
1 Saint Elizabeth Blvd O Fallon IL 62269-1099 |
| Mailing Address |
1145 Corporate Lake Dr Saint Louis MO 63132-2907 |
| Practice Telephone | 6182342120 |
| Mailing Telephone | 3149896843 |
| Mailing Fax Number | 3149897281 |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2020-09-30 |
| Authorized Official Name | KAREN REWERTS (VP FINANCE) |
| Authorized Official Telephone | 3149892034 |
| Is Organization Subpart | Y |
| Parent Organization Name | SSM CARDINAL GLENNON CHILDRENS HOSPITAL |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
Allopathic & Osteopathic Physicians | ||
| N | 2085B0100X |
Radiology Specialization: Body Imaging |
Allopathic & Osteopathic Physicians | ||
| N | 103T00000X | Psychologist | Behavioral Health & Social Service Providers | ||
| N | 104100000X | Social Worker | Behavioral Health & Social Service Providers | ||
| N | 207ZC0500X |
Pathology Specialization: Cytopathology |
Allopathic & Osteopathic Physicians | ||
| N | 2080B0002X |
Pediatrics Specialization: Obesity Medicine |
Allopathic & Osteopathic Physicians | ||
| Y | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 540155801 | 05 |
| Other Name | Type Code |
|---|---|
| SSM Health Cardinal Glennon Children's Hospital | Doing Business As Name - Organization |
| SSM Health Cardinal Glennon Pediatrics | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 13000 Butler Crest Dr, Saint Louis, MO 631284276 | 3148423535 | 3143447281 |
| 226 S Woods Mill Rd Ste 62w, Chesterfield, MO 630173665 | 3144693990 | 3143447281 |
| 1465 S Grand Blvd, Saint Louis, MO 631041003 | 3145775600 | 3142686468 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073568226 | Ssm Cardinal Glennon Childrens Hospital | Pediatrics | 4100 Forest Park Ave Ste 101a, Saint Louis, MO 63108-2885 | 2006-05-24 |
| 1609969880 | Ssm Cardinal Glennon Childrens Hospital | Pharmacy | 1465 S Grand Blvd, Saint Louis, MO 63104-1003 | 2006-10-02 |
| Street Address |
1 SAINT ELIZABETH BLVD |
| City | O FALLON |
| State | IL |
| Zip Code | 62269-1099 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629057302 | St. Elizabeth's Hospital of The Hospital Sisters of The Third Order Of | General Acute Care Hospital | 1 Saint Elizabeth Blvd, O Fallon, IL 62269-1099 | 2006-01-11 |
| 1568084903 | Amanda Sue Burgesen | Registered Nurse | 1 Saint Elizabeth Blvd, O Fallon, IL 62269-1099 | 2020-05-07 |
| 1235764218 | Courtney J Harris | Nurse Anesthetist, Certified Registered | 1 Saint Elizabeth Blvd, O Fallon, IL 62269-1099 | 2020-03-10 |
| 1811532666 | Cindy Lynette Sanden | Nurse Practitioner | 1 Saint Elizabeth Blvd, O Fallon, IL 62269-1099 | 2019-11-14 |
| 1558906750 | Nicole Dawn Brueggemann | Physician Assistant | 1 Saint Elizabeth Blvd, O Fallon, IL 62269-1099 | 2019-11-12 |
| 1912548587 | Adela Redzic | Physician Assistant | 1 Saint Elizabeth Blvd, O Fallon, IL 62269-1099 | 2019-10-03 |
| 1578128732 | Carly Rambo | Registered Nurse | 1 Saint Elizabeth Blvd, O Fallon, IL 62269-1099 | 2019-05-03 |
| 1033670187 | Bart S Bowers | Registered Nurse | 1 Saint Elizabeth Blvd, O Fallon, IL 62269-1099 | 2019-03-29 |
| 1205300795 | Kris Kahler | Radiology | 1 Saint Elizabeth Blvd, O Fallon, IL 62269-1099 | 2019-01-17 |
| 1033615463 | Shambra Cullum | Nurse Practitioner | 1 Saint Elizabeth Blvd, O Fallon, IL 62269-1099 | 2018-04-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326648155 | Kayla Revermann | Pharmacist | 1350 W Us Highway 50, Pharmacy, O Fallon, IL 62269 | 2020-10-30 |
| 1942814272 | Ashley Monique Gibson | Behavior Technician | Eagle Center, Ste 10, Ofallon, IL 62269 | 2020-09-03 |
| 1013533819 | Michelle Denise Voudrie | Registered Nurse | 321 Regency Park, O'fallon, IL 62269 | 2020-06-18 |
| 1598398455 | Washington University Physicians In Illinois - Cancer Center Pharmacy | Pharmacy | 1418 Cross Street, Suite 180, Shiloh, IL 62269 | 2020-02-19 |
| 1962063800 | Gerald Paskert | Pharmacist | 122 W. State St., O'fallon, IL 62269 | 2019-06-21 |
| 1780144808 | Bonnie Jean Lampe | Physical Therapy Assistant | 316 Donna Dr, O'fallon, IL 62269 | 2019-03-24 |
| 1134633993 | Latisha Smith | Psychologist | 600 S. Smiley St., O'fallon, IL 62269 | 2017-11-30 |
| 1619407210 | Brenna M Thomas | Registered Nurse | 1310 Engle Ct, O'fallon, IL 62269 | 2017-06-15 |
| 1881135622 | Pc Associates, LLC | Family Medicine | 800 East Highway 50, O'fallon, IL 62269 | 2017-03-13 |
| 1700230539 | Jennifer Farrell | Family Medicine | 3 St. Elizabeth's Blvd, Ste. 4000, O'fallon, IL 62269 | 2016-04-18 |
| Find all providers in zip 62269 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578792297 | Melissa Roewe | Pediatrics | 9979 Winghaven Blvd Ste 206, O Fallon, MO 63368 | 2009-07-02 |
| 1083842454 | Kimberly N Hackney | Pediatrics | 300 Winding Woods Dr Ste 120, O Fallon, MO 63366-4772 | 2009-06-24 |
| 1881760445 | Thomas Edmund Levrault | Pediatrics | 1337 Park Plaza Dr, Suite 1, O Fallon, IL 62269-1777 | 2006-11-27 |
| 1790730554 | Nuzhat Nisar | Pediatrics | 2954 Highway K, O Fallon, MO 63368-7861 | 2006-05-23 |
| 1881655454 | Jennifer M Hinton | Pediatrics | 1002 Peruque Crossing Ct, Ste 101, O Fallon, MO 63366-2362 | 2006-03-31 |
| 1962478925 | Ella Rozin | Pediatrics | 1001 Highway K, Suite 4, O Fallon, MO 63366-8423 | 2006-02-28 |
| 1013993344 | Guy C Venuti | Pediatrics | 670 Pierce Blvd, O Fallon, IL 62269-2579 | 2005-12-19 |
| 1841281193 | William Stuart Adams | Pediatrics | 9979 Winghaven Blvd, Suite 206, O Fallon, MO 63368-3627 | 2005-11-03 |
| 1619515384 | Emily Caufield | Pediatrics | 604 Pierce Blvd, O Fallon, IL 62269-2588 | 2019-12-12 |
| 1366830572 | Wuca-o'fallon Pediatrics, LLC | Pediatrics | 20 Progress Point Pkwy, Suite 220, O Fallon, MO 63368-2206 | 2014-12-23 |
| Find all providers in O FALLON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.