Unknown Individual – Psychiatry Physician, NPI 1285678805
Psychiatry Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,953 PSYCHIATRY in FL
Provider Addresses for Unknown Individual
4161 TAMIAMI TRL STE 304D
PORT CHARLOTTE, FL 339529254
Phone: (941) 625-5895
Fax: (941) 625-1047
Type: Location
3782 Tamiami Trl
Suite A
Port Charlotte, FL 339528308
Phone: (941) 629-7855
Fax: (941) 629-9589
Type: Location
Box Street, Port Charlotte, Charlotte County, Florida, 33948, United States
PORT CHARLOTTE, FL 339496080
Phone: (941) 629-7855
Fax: (941) 629-9589
Type: Mailing
3782, Tamiami Trail, Central Park, Port Charlotte, Charlotte County, Florida, 33952, United States
SUITE A
PORT CHARLOTTE, FL 339528308
Phone: (941) 629-7855
Fax: (941) 629-9589
Type: Location
PO BOX 512139
PUNTA GORDA, FL 339512139
Phone: (941) 625-5895
Fax: (941) 625-1047
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
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 |
|---|---|---|---|---|
| I20061017000432 | I | Psychiatry | 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 |
|---|---|---|---|---|
| 90838 | Psychotherapy with evaluation and management visit, 1 hour | 164 | 33 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 157 | 31 | $0 |
Insurance plans in this area (ZIP 33952)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| PSYCHIATRY | FL | 90836 | Psychotherapy, 45 minutes with patient and/or family member | 25 | 12 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Mental Health Counselor | FL | |
| Mental Health Counselor | FL | |
| P S Y C H I A T R Y | FL | |
| Nurse Practitioner | FL | |
| Nurse Practitioner | FL | |
| Physician Assistant | FL | |
| Mental Health Counselor | FL |
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