JONATHAN D. FORMAN (M.D.) – Otolaryngology/Facial Plastic Surgery Physician, NPI 1144259078
Otolaryngology/Facial Plastic Surgery Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
732 OTOLARYNGOLOGY in FL
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Provider Addresses for JONATHAN D. FORMAN (M.D.)
508, South Habana Avenue, Palma Ceia Pines, West Tampa, Tampa, Hillsborough County, Florida, 33609, United States
SUITE #170
TAMPA, FL 336094181
Phone: (813) 877-3100
Fax: (813) 877-3800
Type: Location
4606, South Matanzas Avenue, Tampa, Hillsborough County, Florida, 33611, United States
TAMPA, FL 336112748
Phone: (813) 877-3100
Fax: (813) 877-3800
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 15 Open Payments records for all available years, with a total value of $599.
Total Amount is formed as General ($599) + Research ($0) + Ownership ($0) = $599.
Last reported payment date: 2024-11-05 • Largest payer in this snapshot: Merz North America, Inc. ($163).
Total Amount
$599
General + Research + Ownership
Payments
15
Total payment records
General Amount
$599
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-05
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Merz North America, Inc. | $163 |
| DePuy Synthes Sales Inc. | $146 |
| Regeneron Healthcare Solutions, Inc. | $89 |
| Organogenesis Inc. | $56 |
| Acclarent, Inc | $41 |
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: 2006-12-13
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 |
|---|---|---|---|---|
| I20061213000511 | I | Otolaryngology | 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 |
|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 682 | 269 | $0 |
| 31231 | Diagnostic exam of nasal passages using an endoscope | 205 | 142 | $0 |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 116 | 116 | $0 |
| 69210 | Removal of impacted ear wax | 102 | 76 | $0 |
| 31575 | Diagnostic exam of voice box using a flexible endoscope | 85 | 52 | $0 |
Insurance plans in this area (ZIP 33609)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| O T O L A R Y N G O L O G Y | FL | |
| O T O L A R Y N G O L O G Y | FL | |
| Physician Assistant | WI | |
| O T O L A R Y N G O L O G Y | FL | |
| O T O L A R Y N G O L O G Y | FL | |
| O T O L A R Y N G O L O G Y | FL | |
| Qualified Audiologist | FL | |
| Physician Assistant | FL | |
| O T O L A R Y N G O L O G Y | FL | |
| Qualified Audiologist | FL |
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