MICHAEL NEILL CLEMENSHAW (M.D.) – Diagnostic Radiology Physician, NPI 1053531368
Diagnostic Radiology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for MICHAEL NEILL CLEMENSHAW (M.D.)
1120 15TH ST STE BI-1056
AUGUSTA, GA 309120004
Phone: (706) 721-8623
Fax: (706) 721-1459
Type: Mailing
1100 Wilford Hall Loop Bldg 4554
Jbsa Lackland, TX 782365638
Phone: (210) 292-7425
Type: Location
1120 15TH ST
AUGUSTA, GA 309125907
Phone: (706) 721-8623
Type: Location
3551 ROGER BROOKE DR
FORT SAM HOUSTON, TX 782344504
Phone: (210) 539-9582
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
Loading prescription activity...
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.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2019-11-08
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 |
|---|---|---|---|---|
| I20191108002435 | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 30912)
Loading plans...
Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| DIAGNOSTIC RADIOLOGY | TX | 74177 | CT scan of abdomen and pelvis with contrast | 11 | 11 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Interventional Radiology, Diagnostic Radiology | KY | |
| - | GA | |
| - | GA | |
| - | GA | |
| - | GA | |
| - | GA | |
| - | GA | |
| - | SC | |
| - | GA | |
| - | GA |
Reviews
All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.
No reviews yet. Be the first to share your experience — your opinion helps families compare providers.