DR. NICOLE MARIE CANADA (M.D.) – Family Medicine Physician, NPI 1912997180
Family Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
6,722 FAMILY PRACTICE in FL
Provider Addresses for DR. NICOLE MARIE CANADA (M.D.)
9135 58th Dr E
Bradenton, FL 342029188
Phone: (941) 216-6200
Fax: (941) 216-6201
Type: Location
300 Parkview Pl
Lakeland, FL 338054550
Phone: (863) 687-1300
Type: Location
367, South Gulph Road, Gulph Mills Village, King of Prussia, Upper Merion Township, Montgomery County, Pennsylvania, 19406, United States
ATT IPM CREDENTIALING
KING OF PRUSSIA, PA 194063121
Phone: (941) 708-8199
Fax: (941) 708-8194
Type: Mailing
250 2ND ST E STE 4G
BRADENTON, FL 342081028
Phone: (941) 708-8199
Fax: (941) 708-8194
Type: Location
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 $18.
Total Amount is formed as General ($18) + Research ($0) + Ownership ($0) = $18.
Last reported payment date: 2024-08-26 • Largest payer in this snapshot: GlaxoSmithKline, LLC. ($18).
Total Amount
$18
General + Research + Ownership
Payments
1
Total payment records
General Amount
$18
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-08-26
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| GlaxoSmithKline, LLC. | $18 |
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: 2004-11-29
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 |
|---|---|---|---|---|
| I20041129000816 | I | Family Practice | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 34202)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| FAMILY MEDICINE | FL | 82270 | Stool analysis for blood to screen for colon tumors | 24 | 24 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | FL | |
| - | TX | |
| - | FL | |
| - | FL | |
| Physical Medicine And Rehabilitation | MD | |
| Nurse Practitioner | FL | |
| - | FL | |
| Thoracic Surgery | OH | |
| Nurse Practitioner | FL | |
| Family Practice | FL |
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