Ssm Cardinal Glennon Childrens Hospital
NPI 1174577670 · Pediatrics Physician · O Fallon, IL
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Provider details
- NPI number
- 1174577670
- Entity type
- Organization
- Primary specialty
- Pediatrics PhysicianAllopathic & Osteopathic Physicians
- Parent organization
- Ssm Cardinal Glennon Childrens Hospital
- Organization subpart
- Yes
- Authorized official
- Karen Rewerts, Vp Finance(314) 989-2034
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- Psychiatry Physician2084P0800X
Allopathic & Osteopathic Physicians
- Body Imaging Physician2085B0100X
Allopathic & Osteopathic Physicians
- Psychologist103T00000X
Behavioral Health & Social Service Providers
- Social Worker104100000X
Behavioral Health & Social Service Providers
- Cytopathology Physician207ZC0500X
Allopathic & Osteopathic Physicians
- Pediatric Obesity Medicine Physician2080B0002X
Allopathic & Osteopathic Physicians
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
20 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
4 documented practice locations
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Other names (DBA / former)
- Doing business as
- Ssm Health Cardinal Glennon Children'S Hospital
Additional practice locations (3)
- 226 S Woods Mill Rd Ste 62wChesterfield, MO 63017-3665Phone: (314) 469-3990Fax: (314) 344-7281
- 1465 S Grand BlvdSaint Louis, MO 63104-1003Phone: (314) 577-5600Fax: (314) 268-6468
- 13000 Butler Crest DrSaint Louis, MO 63128-4276Phone: (314) 842-3535Fax: (314) 344-7281
Registry dates
- Enumerated
- 2006-05-19
- Last updated
- 2020-09-30
- Certified
- 2020-08-24
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.