Unknown Individual – Geriatric Medicine (Family Medicine) Physician, NPI 1013909068
Geriatric Medicine (Family Medicine) Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
1230, East 164th Street, South Holland, Thornton Township, Cook County, Illinois, 60473, United States
SOUTH HOLLAND, IL 604733210
Phone: (219) 864-2107
Fax: (219) 864-2649
Type: Mailing
732 ROYAL DUBLIN LN
DYER, IN 463111273
Phone: (708) 705-0123
Fax: (219) 227-9077
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 2 Open Payments records for all available years, with a total value of $27.
Total Amount is formed as General ($27) + Research ($0) + Ownership ($0) = $27.
Last reported payment date: 2023-04-27 • Largest payer in this snapshot: Novartis Pharmaceuticals Corporation ($27).
Total Amount
$27
General + Research + Ownership
Payments
2
Total payment records
General Amount
$27
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-04-27
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Novartis Pharmaceuticals Corporation | $27 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
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 |
|---|---|---|---|---|
| I20050608000971 | I | Family Practice | IN | 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 60473)
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Reviews
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