MS. MODUPE D MCINTOSH (CPNP) – Psychiatric/Mental Health Nurse Practitioner, NPI 1174522916
Psychiatric/Mental Health Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
9,652 NURSE PRACTITIONER in GA
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Provider Addresses for MS. MODUPE D MCINTOSH (CPNP)
635, Beaver Ruin Road, Luxomni, Lilburn, Gwinnett County, Georgia, 30047, United States
SUITE B
LILBURN, GA 300473474
Phone: (678) 807-2230
Fax: (770) 267-5710
Type: Location
13577 FEATHER SOUND DR
CLEARWATER, FL 337622258
Phone: (904) 902-4408
Fax: (904) 420-4745
Type: Location
635 Beaver Ruin Rd NW
Suite B
Lilburn, GA 300473474
Phone: (678) 807-2230
Fax: (770) 267-5710
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 3 Open Payments records for all available years, with a total value of $58.
Total Amount is formed as General ($58) + Research ($0) + Ownership ($0) = $58.
Last reported payment date: 2024-06-14 • Largest payer in this snapshot: Takeda Pharmaceuticals U.S.A., Inc. ($23).
Total Amount
$58
General + Research + Ownership
Payments
3
Total payment records
General Amount
$58
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-06-14
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Takeda Pharmaceuticals U.S.A., Inc. | $23 |
| IRONSHORE PHARMACEUTICALS INC. | $18 |
| Janssen Biotech, Inc. | $17 |
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: 2024-04-23
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 |
|---|---|---|---|---|
| I20240423002795 | I | Nurse Practitioner | 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 30047)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | UT | |
| P S Y C H I A T R Y | AZ | |
| Nurse Practitioner | AZ | |
| Geriatric Psychiatry, Psychiatry | IN | |
| P S Y C H I A T R Y | CO | |
| P S Y C H I A T R Y | FL | |
| P S Y C H I A T R Y | AZ | |
| P S Y C H I A T R Y | TX | |
| P S Y C H I A T R Y | AZ | |
| Nurse Practitioner | FL |
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