Unknown Individual – Psychiatry Physician, NPI 1417060427
Psychiatry Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
2635, East Cedar Avenue, Denver, Denver County, Colorado, 80209, United States
DENVER, CO 802093205
Phone: (720) 470-1856
Fax: (307) 460-7417
Mailing address matches the actual address.
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: 2023-08-22
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 9 Medicare enrollment records; no due dates published yet.
Enrollment records
9
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 |
|---|---|---|---|---|
| I20120130000589 | I | Psychiatry | CO | TBD |
| I20141105002437 | I | Psychiatry | NV | TBD |
| I20181119001359 | I | Psychiatry | CA | TBD |
| I20201116002616 | I | Psychiatry | OR | TBD |
| I20211020001544 | I | Psychiatry | FL | TBD |
| I20230412002487 | I | Psychiatry | WA | TBD |
| I20230720002808 | I | Psychiatry | SC | TBD |
| I20230801003517 | I | Psychiatry | HI | TBD |
| I20230822002692 | I | Psychiatry | AZ | 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 |
|---|---|---|---|---|
| G0426 | Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth | 13 | 13 | $0 |
Insurance plans in this area (ZIP 80209)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | CO | |
| P S Y C H I A T R Y | WV | |
| P S Y C H I A T R Y | CA | |
| - | CA | |
| - | CA | |
| P S Y C H I A T R Y | CA | |
| P S Y C H I A T R Y | NC | |
| P S Y C H I A T R Y | CA | |
| P S Y C H I A T R Y | CA | |
| P S Y C H I A T R Y | WA |
Reviews
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