OTIS PERRY MAX INGERSOLL (FNP) – Family Nurse Practitioner, NPI 1386838407
Family Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for OTIS PERRY MAX INGERSOLL (FNP)
2850 Telegraph Ave
#130
Berkeley, CA 947051192
Phone: (510) 204-8110
Fax: (510) 843-0804
Type: Location
Sutter Health East Bay, 500, San Pablo Avenue, Albany, Contra Costa County, California, 94706, United States
ALBANY, CA 947061103
Phone: (510) 204-8130
Fax: (510) 524-0861
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
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: 2011-02-23
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 |
|---|---|---|---|---|
| I20110223000875 | I | Nurse Practitioner | CA | 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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 150 | 74 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 31 | 27 | $0 |
| 99215 | Established patient office or other outpatient visit, 40-54 minutes | 29 | 24 | $0 |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 26 | 26 | $0 |
| 90694 | Influenza vaccine, quadrivalent inactivated, 0.5 ml dosage | 12 | 12 | $0 |
Insurance plans in this area (ZIP 94705)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| D E R M A T O L O G Y | CA | |
| A L L E R G Y/ I M M U N O L O G Y | CA | |
| - | CA | |
| Hospitalist, Obstetrics/Gynecology | CA | |
| O B S T E T R I C S/ G Y N E C O L O G Y | OR | |
| - | CA | |
| - | CA | |
| - | CA | |
| - | CA | |
| A N E S T H E S I O L O G Y | CA |
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