Unknown Individual – Family Medicine Physician, NPI 1861464299
Family Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
13,194 FAMILY PRACTICE in CA
Provider Addresses for Unknown Individual
95TH MEDICAL GROUP/SGOP
30 NIGHTINGALE RD
EDWARDS AFB, CA 935240001
Phone: (661) 275-2688
Type: Location
Holline Court, Lancaster, Los Angeles County, California, 93535, United States
LANCASTER, CA 935354910
Phone: (661) 946-5158
Type: Mailing
1523 W AVENUE J STE 7
LANCASTER, CA 935342819
Phone: (661) 816-8478
Fax: (661) 945-0831
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 36 Open Payments records for all available years, with a total value of $844.
Total Amount is formed as General ($844) + Research ($0) + Ownership ($0) = $844.
Last reported payment date: 2024-12-03 • Largest payer in this snapshot: CSL Behring ($208).
Total Amount
$844
General + Research + Ownership
Payments
36
Total payment records
General Amount
$844
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-03
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| CSL Behring | $208 |
| SANOFI PASTEUR INC. | $79 |
| Octapharma USA, Inc. | $60 |
| Takeda Pharmaceuticals U.S.A., Inc. | $53 |
| Lilly USA, LLC | $46 |
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 |
|---|---|---|---|---|
| I20060823000404 | I | Family Practice | 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 |
|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 1,010 | 439 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 971 | 331 | $0 |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 259 | 259 | $0 |
| J1100 | Injection, dexamethasone sodium phosphate, 1 mg | 207 | 20 | $0 |
| 96365 | Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less | 196 | 18 | $0 |
Insurance plans in this area (ZIP 93524)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Pediatric Medicine, Allergy/Immunology | CA | |
| Nurse Practitioner | CA | |
| General Surgery, Vascular Surgery | CA | |
| Nurse Practitioner | CA |
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