GRACE DIANA TICE (PA-C) – Physician Assistant, NPI 1104541937
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
9,231 PHYSICIAN ASSISTANT in FL
Provider Addresses for GRACE DIANA TICE (PA-C)
1235 AUGUSTA ST E
LEHIGH ACRES, FL 339740728
Phone:
Type: Mailing
1641 TAMIAMI TRL STE 1
PORT CHARLOTTE, FL 339481018
Phone: (941) 629-6262
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 6 Open Payments records for all available years, with a total value of $345.
Total Amount is formed as General ($345) + Research ($0) + Ownership ($0) = $345.
Last reported payment date: 2024-10-15 • Largest payer in this snapshot: Ethicon US, LLC ($144).
Total Amount
$345
General + Research + Ownership
Payments
6
Total payment records
General Amount
$345
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-10-15
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Ethicon US, LLC | $144 |
| Bioventus LLC | $69 |
| Bayer Healthcare Pharmaceuticals Inc. | $68 |
| Medtronic, Inc. | $35 |
| Coastal Medical Technologies Llc | $28 |
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: 2022-10-17
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 |
|---|---|---|---|---|
| I20221017002761 | I | Physician Assistant | FL | 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 |
|---|---|---|---|---|
| J7328 | Hyaluronan or derivative, gelsyn-3, for intra-articular injection, 0.1 mg | 17,642 | 38 | $0 |
| J7329 | Hyaluronan or derivative, trivisc, for intra-articular injection, 1 mg | 801 | 19 | $0 |
| J0702 | Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg | 668 | 183 | $0 |
| 20610 | Aspiration and/or injection of fluid from large joint | 441 | 249 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 229 | 192 | $0 |
Insurance plans in this area (ZIP 33974)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Orthopedic Surgery | FL | |
| Physician Assistant | FL | |
| Orthopedic Surgery | FL | |
| Orthopedic Surgery | FL | |
| Orthopedic Surgery, Sports Medicine | FL | |
| Orthopedic Surgery | FL | |
| Physician Assistant | FL | |
| Physical Therapist In Private Practice | FL | |
| Physical Therapist In Private Practice | FL | |
| Physician Assistant | FL |
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