MISS MONICA TIRTARAHARDJA (PA-C) – Surgical Physician Assistant, NPI 1770117830

MISS MONICA TIRTARAHARDJA (PA-C) is a healthcare provider. based in Atlantis, Florida. specializing in PHYSICIAN ASSISTANT. They hold the professional credentials PA-C. They hold a License No. PA9112886 (FL). The NPI Number for MISS MONICA TIRTARAHARDJA (PA-C) is 1770117830

Main info

Female
Sole Proprietor
7 Years Of Experience
Accepts Medicare Assignment
Name
MISS MONICA TIRTARAHARDJA (PA-C)
NPI
1770117830
Phone
(561) 410-5110
Address
5503 S CONGRESS AVE STE 204
Enumeration Date
27 February 2020
Last Update Date
12 July 2020

Doctor Profile

Medical School Name
OTHER
Secondary Phone
5614105110
Graduation Year
2019 (7 years ago)
PAC ID
6103249503
Group Practice PAC ID
9436389970
Professional Enrollment ID
I20200701002662
Address ID
FL334626626AT5503XAVEX400
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience36
Completeness75
Years active:6State licenses:1Digital endpointsOther names

9,232 PHYSICIAN ASSISTANT in FL

Provider Addresses for MISS MONICA TIRTARAHARDJA (PA-C)

  • 5503 S CONGRESS AVE STE 204

    ATLANTIS, FL 334626626

    Phone: (561) 410-5110

    Fax: (561) 328-3911

    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 7 Open Payments records for all available years, with a total value of $291.

Total Amount is formed as General ($291) + Research ($0) + Ownership ($0) = $291.

Last reported payment date: 2024-09-11 • Largest payer in this snapshot: Medical Device Business Services, Inc. ($139).

Total Amount

$291

General + Research + Ownership

Payments

7

Total payment records

General Amount

$291

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-09-11

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

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: 2020-07-01

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

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20200701002662IPhysician AssistantFLTBD

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.

Verify on CMS Revalidation Lookup Tool

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

HCPCSDescriptionServicesBeneficiariesMedicare allowed
22614Fusion of additional segment of spine5716$0
View full utilization report →

Insurance plans in this area (ZIP 33462)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 9436389970View full group profile
NameSpecialtyState
-FL
N E U R O S U R G E R YFL

Reviews

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Frequently asked questions

What unique ID ties claims to MISS MONICA TIRTARAHARDJA (PA-C)?
NPI 1770117830 is assigned to MISS MONICA TIRTARAHARDJA (PA-C) under the national enumeration system.
Does this profile mean MISS MONICA TIRTARAHARDJA (PA-C) is currently active?
Yes — MISS MONICA TIRTARAHARDJA (PA-C) appears active in the national provider directory.
What field does MISS MONICA TIRTARAHARDJA (PA-C) work in?
You can think of MISS MONICA TIRTARAHARDJA (PA-C) as practicing within Surgical Physician Assistant. Clinical services aligned with this taxonomy classification.
Where is MISS MONICA TIRTARAHARDJA (PA-C)'s primary listing?
We display Atlantis, Florida because that is what the record indicates for MISS MONICA TIRTARAHARDJA (PA-C).
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

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