Unknown Individual – Physician Assistant, NPI 1407925209
Physician Assistant
Main info
Doctor Profile
Contacts
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
4065, County Circle Drive, Riverside, Riverside County, California, 92503, United States
ROOM 309
RIVERSIDE, CA 925033410
Phone: (951) 358-5222
Fax: (951) 358-5235
Type: Mailing
2499, East Lakeshore Drive, Lake Elsinore, Riverside County, California, 92530, United States
LAKE ELSINORE, CA 925304411
Phone: (951) 471-4200
Fax: (951) 471-4205
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $14.
Total Amount is formed as General ($14) + Research ($0) + Ownership ($0) = $14.
Last reported payment date: 2023-07-26 • Largest payer in this snapshot: ATRICURE, INC. ($14).
Total Amount
$14
General + Research + Ownership
Payments
1
Total payment records
General Amount
$14
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-07-26
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ATRICURE, INC. | $14 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
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 |
|---|---|---|---|---|
| I20121004000418 | I | Physician Assistant | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 92503)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| U R O L O G Y | OH | |
| Nurse Practitioner | CA | |
| Internal Medicine | CA | |
| Internal Medicine | CA | |
| Internal Medicine, Gastroenterology | CA | |
| Physician Assistant | CA | |
| Emergency Medicine | NC | |
| O P H T H A L M O L O G Y | CA | |
| Anesthesiology, Pain Management | NH | |
| Family Practice, Sports Medicine | CA |
Reviews
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