ETERN S PARK (DDS, MD) – Oral and Maxillofacial Surgery (Dentist), NPI 1124289905
Oral and Maxillofacial Surgery (Dentist)
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
7 ORAL SURGERY in DE
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Provider Addresses for ETERN S PARK (DDS, MD)
501 W 14TH ST STE 2W44
WILMINGTON, DE 198011013
Phone: (302) 320-5730
Type: Mailing
501, West 14th Street, Midtown Brandywine, Wilmington, New Castle County, Delaware, 19801, United States
SUITE 2W44, WILMINGTON HOSPITAL
WILMINGTON, DE 198012200
Phone: (302) 320-5730
Type: Location
PO BOX 5074
SIOUX FALLS, SD 571175074
Phone: (605) 328-6585
Type: Mailing
1717 UNIVERSITY DR S
FARGO, ND 581034939
Phone: (701) 234-2000
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 5 Open Payments records for all available years, with a total value of $111.
Total Amount is formed as General ($111) + Research ($0) + Ownership ($0) = $111.
Last reported payment date: 2024-08-30 • Largest payer in this snapshot: DePuy Synthes Sales Inc. ($50).
Total Amount
$111
General + Research + Ownership
Payments
5
Total payment records
General Amount
$111
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-08-30
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| DePuy Synthes Sales Inc. | $50 |
| Medical Device Business Services, Inc. | $31 |
| KLS-Martin L.P. | $29 |
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: 2024-08-13
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
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 |
|---|---|---|---|---|
| I20160908002619 | I | Oral Surgery | DE | TBD |
| I20240813003978 | I | Oral Surgery | ND | 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 | 77 | 51 | $0 |
| 99202 | New patient office or other outpatient visit, 15-29 minutes | 59 | 59 | $0 |
| 99212 | Established patient office or other outpatient visit, 10-19 minutes | 16 | 16 | $0 |
| 92511 | Exam of the nose and throat using an endoscope | 12 | 11 | $0 |
Insurance plans in this area (ZIP 19801)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | ND | |
| Nurse Practitioner | ND | |
| - | ND | |
| - | ND | |
| P S Y C H I A T R Y | ND | |
| - | PA | |
| N E P H R O L O G Y | SD | |
| U R O L O G Y | MI | |
| Nurse Practitioner | ND | |
| H O S P I T A L I S T | ND |
Reviews
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