MR. NICHOLAS ALEXANDER JR. PUKISH (PA-C) – Medical Physician Assistant, NPI 1073539771
Medical Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
9,231 PHYSICIAN ASSISTANT in FL
Provider Addresses for MR. NICHOLAS ALEXANDER JR. PUKISH (PA-C)
1825 HURLBURT RD STE 14
FORT WALTON BEACH, FL 325473737
Phone: (850) 610-8820
Fax: (844) 297-8690
Type: Location
1825 Hurlburt Rd Ste 14
Fort Walton Beach, FL 325473737
Phone: (850) 610-8820
Fax: (844) 297-8690
Type: Location
4300 Bayou Blvd Ste 17D
Pensacola, FL 325032671
Phone: (850) 476-3131
Type: Location
6255 W SUNSET BLVD FL 21
LOS ANGELES, CA 900287422
Phone: (323) 860-5200
Fax: (323) 467-7119
Type: Mailing
189 WALMART LN STE B
BILOXI, MS 395314564
Phone: (601) 368-6254
Type: Location
Fruitville Road, Sarasota County, Florida, United States of America
SARASOTA, FL 342321926
Phone: (941) 366-0134
Fax: (941) 404-1760
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 12 Open Payments records for all available years, with a total value of $290.
Total Amount is formed as General ($290) + Research ($0) + Ownership ($0) = $290.
Last reported payment date: 2023-06-29 • Largest payer in this snapshot: ViiV Healthcare Company ($93).
Total Amount
$290
General + Research + Ownership
Payments
12
Total payment records
General Amount
$290
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-06-29
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ViiV Healthcare Company | $93 |
| Theratechnologies Inc. | $91 |
| Merck Sharp & Dohme LLC | $49 |
| Napo Pharmaceuticals Inc | $43 |
| ABBVIE INC. | $14 |
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: 2025-09-18
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 |
|---|---|---|---|---|
| I20060125000107 | I | Physician Assistant | FL | TBD |
| I20250918003848 | I | Physician Assistant | MS | 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 32547)
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