SSM HEALTH CARDINAL GLENNON CHILDREN'S HOSPITAL
NPI 1174577670
Pediatrics in O Fallon, IL

Q: What is Ssm Cardinal Glennon Childrens Hospital's specialty?

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

Active since May 19, 2006CLIA Certified · 2 labs

1 SAINT ELIZABETH BLVD, O FALLON, IL 62269(618) 234-2120 Get Directions Write a Review

NPPES record last updated: September 30, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Sep 30, 2020, Oct 23, 2019, Dec 14, 2018 and 2 more (5 updates tracked since 2018).

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About Ssm Health Cardinal Glennon Children's Hospital NPPES

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

SSM HEALTH CARDINAL GLENNON CHILDREN'S HOSPITAL (NPI 1174577670) is a healthcare organization registered as a pediatrics in O Fallon, Illinois and active in the NPI registry since May 2006. The organization holds 2 active CLIA laboratory certificates, maintains 3 additional practice locations, and lists Karen Rewerts, Vp Finance, as its authorized official.

NPPES Registry Identity

NPI1174577670

Entity TypeOrganization

Primary Taxonomy208000000X

Legal Business NameSSM CARDINAL GLENNON CHILDRENS HOSPITAL

Location Address1 SAINT ELIZABETH BLVDO Fallon, IL 62269-1099

Mailing Address1145 Corporate Lake DrSaint Louis, MO 63132-2907 · (314) 989-6843 · Fax (314) 989-7281

Phone(618) 234-2120

Organization SubpartYes

Authorized OfficialKaren RewertsVp Finance · (314) 989-2034

Enumeration DateMay 19, 2006

Last NPPES UpdateSeptember 30, 20205 updates tracked since enumeration

NPPES CertifiedAugust 24, 2020

✔ NPI 1174577670 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 7

★ 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.

Also ListedPsychologistTaxonomy 103T00000X

Also ListedSocial WorkerTaxonomy 104100000X

Also ListedPathology · CytopathologyTaxonomy 207ZC0500X

Also ListedPediatrics · Obesity MedicineTaxonomy 2080B0002X

Also ListedPsychiatry & Neurology · PsychiatryTaxonomy 2084P0800X

Also ListedRadiology · Body ImagingTaxonomy 2085B0100X

1 SAINT ELIZABETH BLVD, O Fallon, IL 62269

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Other Names 1

Doing Business AsSsm Health Cardinal Glennon Children's Hospital

Secondary Practice Locations 3

Location 1226 S Woods Mill Rd Ste 62WChesterfield, MO 63017-3665 · Phone (314) 469-3990 · Fax (314) 344-7281

Location 213000 Butler Crest DrSaint Louis, MO 63128-4276 · Phone (314) 842-3535 · Fax (314) 344-7281

Location 31465 S Grand BlvdSaint Louis, MO 63104-1003 · Phone (314) 577-5600 · Fax (314) 268-6468

Other Identifiers 1

Medicaid540155801MO

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Home State Health, Ambetter from Sunflower Health Plan and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA 2

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 26D2191210

Ssm Health Cardinal Glennon Pediatric Urgent Care · Saint Louis, MO

Active · expires Aug 24, 2026

CLIA Number26D2191210

Laboratory TypeUrgent Care

Certificate Effective DateAugust 25, 2024

Certificate Expiration DateAugust 24, 2026

Laboratory DirectorTrevor L. Tredway

Laboratory Phone(314) 842-3535

Laboratory LocationSsm Health Cardinal Glennon Pediatric Urgent Care13000 Butler Crest Drive, Saint Louis, MO 63128

CLIA data matches this NPI record on: Address Phone

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

Certificate of Waiver 26D2026531

Ssm Health Cardinal Glennon Pediatric Specialty Clinic · Saint Louis, MO

Active · expires Jun 30, 2027

CLIA Number26D2026531

Laboratory TypeHospital Outpatient Depar

Certificate Effective DateJuly 1, 2025

Certificate Expiration DateJune 30, 2027

Laboratory DirectorMelissa Novacich

Laboratory Phone(314) 268-4082

Laboratory LocationSsm Health Cardinal Glennon Pediatric Specialty Clinic13000 Butler Crest Drive, Saint Louis, MO 63128

CLIA data matches this NPI record on: Address

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

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Other Providers at the Same Location NPPES 20

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

ST ELIZABETHS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER

Rehabilitation Unit