MIKHAIL WENUTU FRASER-GRAY (PA-C) – Physician Assistant, NPI 1760648117
Physician Assistant
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Profile Insights
NPPES metrics only — not quality of care.
10,570 PHYSICIAN ASSISTANT in CA
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Provider Addresses for MIKHAIL WENUTU FRASER-GRAY (PA-C)
111, Sepulveda Boulevard, Manhattan Beach, Los Angeles County, California, 90266, United States
SUITE 210
MANHATTAN BEACH, CA 902666861
Phone: (310) 379-2134
Fax: (310) 379-4856
Type: Mailing
869, North Cherry Street, Tulare, Tulare County, California, 93274, United States
TULARE, CA 932742207
Phone: (559) 688-0821
Fax: (818) 587-2493
Type: Location
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: 2009-02-02
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 |
|---|---|---|---|---|
| I20090202000397 | 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 90266)
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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 |
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