REDBIRD PEDIATRICS, PLLC
NPI 1124634449
Pediatrics in O Fallon, IL

Q: What is Redbird Pediatrics, PLLC's NPI number?

The NPI number for Redbird Pediatrics, PLLC is 1124634449. It was assigned to this organization in the NPPES registry on September 22, 2020.

Q: What is Redbird Pediatrics, PLLC's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Active since September 22, 2020CLIA 14D2205128 · Waiver

793 SUNSET BLVD, O FALLON, IL 62269(618) 668-2473 Get Directions Write a Review

NPPES record last updated: March 2, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Mar 2, 2021, Jan 1, 2021, Nov 16, 2020 and 1 more (4 updates tracked since 2020).

On this page

About Redbird Pediatrics, Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

REDBIRD PEDIATRICS, PLLC (NPI 1124634449) is a healthcare organization registered as a pediatrics in O Fallon, Illinois and active in the NPI registry since September 2020. The organization holds a CLIA Waiver certificate valid through December 11, 2026, maintains a secondary practice location in Shiloh, and lists Kevin Ponciroli, Pediatrician, as its authorized official.

NPPES Registry Identity

NPI1124634449

Entity TypeOrganization

Primary Taxonomy208000000X

Legal Business NameREDBIRD PEDIATRICS, PLLC

Location Address793 SUNSET BLVDO Fallon, IL 62269-1960

Mailing Address793 Sunset BlvdO Fallon, IL 62269-1960 · (618) 668-2473

Phone(618) 668-2473

Organization SubpartNo

Authorized OfficialKevin PonciroliPediatrician · (618) 668-2473

Enumeration DateSeptember 22, 2020

Last NPPES UpdateMarch 2, 20214 updates tracked since enumeration

NPPES CertifiedMarch 2, 2021

✔ NPI 1124634449 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians

Taxonomy Code208000000X

Definition

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.

793 SUNSET BLVD, O Fallon, IL 62269

Open in Google Maps ↗

Secondary Practice Location 1

Location 1914 Red Scarlet CtShiloh, IL 62221-8306 · Phone (618) 972-7422

Other Identifiers 1

Medicaid1598776411IL

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Home State Health, Ambetter Health, Ambetter Health of Delaware.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 14D2205128

Redbird Pediatrics · O Fallon, IL

Active · expires Dec 11, 2026

CLIA Number14D2205128

Laboratory TypePhysician Office

Certificate Effective DateDecember 12, 2024

Certificate Expiration DateDecember 11, 2026

Laboratory DirectorKevin M. Ponciroli

Laboratory Phone(618) 668-2473

Laboratory LocationRedbird Pediatrics793 Sunset Blvd, O Fallon, IL 62269

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. KEVIN M PONCIROLI M.D.

Pediatrics

793 SUNSET BLVD
O FALLON, IL 62269

St. Clair County (618) 668-2473

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Redbird Pediatrics, PLLC's NPI number?

The NPI number for Redbird Pediatrics, PLLC is 1124634449. It was assigned to this organization in the NPPES registry on September 22, 2020.

Where is Redbird Pediatrics, PLLC located?

Redbird Pediatrics, PLLC is located at 793 Sunset Blvd, O Fallon, IL 62269. The listed phone number is (618) 668-2473.

What is Redbird Pediatrics, PLLC's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Does Redbird Pediatrics, PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 14D2205128) is associated with this NPI, valid through December 11, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Redbird Pediatrics, PLLC accept?

Health plans from Ambetter Health, Ambetter Health of Delaware and Ambetter from Home State Health list Redbird Pediatrics, PLLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Redbird Pediatrics, PLLC was last updated on March 2, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.