EVELINE RUSDIANTO KLENOTIC (DO, FACS) – Surgery Physician, NPI 1801185541
Surgery Physician
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Profile Insights
NPPES metrics only — not quality of care.
300 GENERAL SURGERY in AR
Provider Addresses for EVELINE RUSDIANTO KLENOTIC (DO, FACS)
4301 W Markham St # 725
Little Rock, AR 722057101
Phone: (501) 296-1200
Fax: (501) 686-8551
Type: Location
5105 SOM CENTER RD
STE 107
WILLOUGHBY, OH 440944203
Phone: (440) 953-5712
Fax: (440) 953-5713
Type: Mailing
400 WABASH AVE
AKRON, OH 443072433
Phone: (330) 344-6000
Type: Location
PO BOX 80690
CANTON, OH 447080690
Phone: (330) 363-7444
Fax: (330) 363-7770
Type: Mailing
2600 SIXTH ST SW
CANTON, OH 447101702
Phone: (330) 344-6000
Type: Location
4301 W MARKHAM ST # 783
LITTLE ROCK, AR 722057101
Phone: (501) 686-8000
Fax: (501) 526-5148
Type: Mailing
4301 W MARKHAM ST # 725
LITTLE ROCK, AR 722057101
Phone: (501) 296-1200
Fax: (501) 686-8551
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 5 Open Payments records for all available years, with a total value of $711.
Total Amount is formed as General ($711) + Research ($0) + Ownership ($0) = $711.
Last reported payment date: 2024-08-20 • Largest payer in this snapshot: LEICA MICROSYSTEMS INC. ($210).
Total Amount
$711
General + Research + Ownership
Payments
5
Total payment records
General Amount
$711
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-08-20
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| LEICA MICROSYSTEMS INC. | $210 |
| Solventum Corporation | $167 |
| Endomagnetics Ltd | $153 |
| Tempus AI, Inc | $96 |
| Seagen Inc. | $85 |
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: 2016-10-13
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
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 |
|---|---|---|---|---|
| I20161013001706 | I | General Surgery | OH | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
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 72205)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | GA | |
| - | OH | |
| Critical Care (Intensivists) | KY | |
| - | OH | |
| Family Practice | OH | |
| Family Practice | OH | |
| Cardiovascular Disease (Cardiology) | OH | |
| N E P H R O L O G Y | OH | |
| Nurse Practitioner | OH | |
| General Surgery | IL |
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