ESRAVILA ARIYA WIBISONO (MD) – Internal Medicine Physician, NPI 1972233708
Internal Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
3,447 INTERNAL MEDICINE in CT
Provider Addresses for ESRAVILA ARIYA WIBISONO (MD)
56 Franklin St Ste 1
Waterbury, CT 067061281
Phone: (203) 709-8685
Fax: (203) 709-3518
Type: Location
56 FRANKLIN ST STE 1
WATERBURY, CT 067061281
Phone: (203) 709-8685
Fax: (203) 709-3518
Type: Mailing
10004 204TH AVE E STE 2200
BONNEY LAKE, WA 983916537
Phone: (253) 447-3300
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
Loading prescription activity...
Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $135.
Total Amount is formed as General ($135) + Research ($0) + Ownership ($0) = $135.
Last reported payment date: 2023-01-09 • Largest payer in this snapshot: Abbott Laboratories ($135).
Total Amount
$135
General + Research + Ownership
Payments
1
Total payment records
General Amount
$135
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-01-09
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Abbott Laboratories | $135 |
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: 2025-09-09
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 |
|---|---|---|---|---|
| I20250909004774 | I | Internal Medicine | WA | 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 06706)
Loading plans...
Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | WA | |
| Nurse Practitioner | WA | |
| - | IL | |
| O P H T H A L M O L O G Y | OR | |
| O P H T H A L M O L O G Y | WA | |
| Nurse Practitioner | WA | |
| Family Practice | WA | |
| Interventional Radiology, Diagnostic Radiology | OH | |
| Physician Assistant | ID | |
| Clinical Psychologist | WA |
Reviews
All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.
No reviews yet. Be the first to share your experience — your opinion helps families compare providers.