DR. JANI WIDJAJA (MD) – Diagnostic Radiology Physician, NPI 1902881287
Diagnostic Radiology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,271 DIAGNOSTIC RADIOLOGY in GA
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Provider Addresses for DR. JANI WIDJAJA (MD)
2555, Ponce de Leon Boulevard, Coral Gables, Miami-Dade County, Florida, 33134, United States
4TH FLOOR
CORAL GABLES, FL 331346010
Phone: (305) 702-5135
Fax: (305) 441-2144
Type: Mailing
Gwinnett Medical Center, 1000, Medical Center Boulevard, Lawrenceville, Gwinnett County, Georgia, 30046, United States
RADIOLOGY DEPT
LAWRENCEVILLE, GA 300457694
Phone: (770) 995-4321
Type: Location
PO BOX 1746
INDIANAPOLIS, IN 462061746
Phone: (877) 383-4442
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $66.
Total Amount is formed as General ($66) + Research ($0) + Ownership ($0) = $66.
Last reported payment date: 2023-04-22 • Largest payer in this snapshot: GE HealthCare ($66).
Total Amount
$66
General + Research + Ownership
Payments
1
Total payment records
General Amount
$66
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-04-22
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| GE HealthCare | $66 |
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: 2006-08-15
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 |
|---|---|---|---|---|
| I20060815000000 | I | Diagnostic Radiology | GA | 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 |
|---|---|---|---|---|
| 71045 | X-ray of chest, 1 view | 523 | 476 | $0 |
| 77067 | Screening mammography | 174 | 174 | $0 |
| 70450 | Ct scan head or brain without contrast | 165 | 163 | $0 |
| 71046 | X-ray of chest, 2 views | 143 | 143 | $0 |
| 77063 | Screening 3d breast mammography | 123 | 123 | $0 |
Insurance plans in this area (ZIP 33134)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| DIAGNOSTIC RADIOLOGY | GA | 71010 | X-ray of chest, 1 view, front | 579 | 514 |
| DIAGNOSTIC RADIOLOGY | GA | 71250 | CT scan chest | 129 | 129 |
| DIAGNOSTIC RADIOLOGY | GA | 74177 | CT scan of abdomen and pelvis with contrast | 133 | 132 |
| DIAGNOSTIC RADIOLOGY | GA | 93971 | Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers | 75 | 74 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Diagnostic Radiology | GA | |
| Diagnostic Radiology | IN | |
| Diagnostic Radiology | GA | |
| Diagnostic Radiology | GA | |
| Diagnostic Radiology | GA | |
| Diagnostic Radiology | GA | |
| Diagnostic Radiology | GA | |
| Diagnostic Radiology | GA | |
| Nurse Practitioner | GA | |
| Diagnostic Radiology | GA |
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