DR. MITZI C BROCK (MD) – Gynecology Physician, NPI 1417956970
Gynecology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
2,540 OBSTETRICS/GYNECOLOGY in FL
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Provider Addresses for DR. MITZI C BROCK (MD)
San Jose Boulevard, San Jose, Jacksonville, Duval County, Florida, 32217, United States
JACKSONVILLE, FL 322231627
Phone: (904) 262-5333
Fax: (904) 262-5337
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 35 Open Payments records for all available years, with a total value of $648.
Total Amount is formed as General ($648) + Research ($0) + Ownership ($0) = $648.
Last reported payment date: 2024-12-05 • Largest payer in this snapshot: Exact Sciences Corporation ($79).
Total Amount
$648
General + Research + Ownership
Payments
35
Total payment records
General Amount
$648
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
2
Ownership records
Last Payment Date
2024-12-05
Latest reported date
Top Companies
Largest payers in this snapshot
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: 2005-01-04
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 |
|---|---|---|---|---|
| I20050104000613 | I | Obstetrics/Gynecology | 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 |
|---|---|---|---|---|
| G0101 | Cervical or vaginal cancer screening; pelvic and clinical breast examination | 39 | 39 | $0 |
| 77063 | Screening 3d breast mammography | 38 | 38 | $0 |
| 77067 | Screening mammography | 38 | 38 | $0 |
| Q0091 | Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory | 27 | 27 | $0 |
Insurance plans in this area (ZIP 32223)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | FL | |
| - | FL | |
| O B S T E T R I C S/ G Y N E C O L O G Y | FL | |
| - | FL | |
| - | FL | |
| - | CO | |
| Nurse Practitioner | FL | |
| O B S T E T R I C S/ G Y N E C O L O G Y | FL | |
| O B S T E T R I C S/ G Y N E C O L O G Y | FL | |
| O B S T E T R I C S/ G Y N E C O L O G Y | FL |
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