MCKENNA A GOTTFRIED – Nurse Practitioner, NPI 1003328592
Nurse Practitioner
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Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
8,241 NURSE PRACTITIONER in IN
Provider Addresses for MCKENNA A GOTTFRIED
3909 NEW VISION DR
FORT WAYNE, IN 468451725
Phone: (260) 425-5500
Fax: (260) 425-5525
Type: Location
3702 NEW VISION DR BLDG B
FORT WAYNE, IN 468451703
Phone:
Type: Mailing
11109 PARKVIEW PLAZA DR # 117
FORT WAYNE, IN 468451701
Phone:
Type: Mailing
442 W High St
Bryan, OH 435061681
Phone: (419) 636-4517
Fax: (419) 636-6438
Type: Location
Parkview Physicians Group, 5693, YMCA Park Drive West, Fort Wayne, Allen County, Indiana, 46885, United States
FORT WAYNE, IN 468353280
Phone: (260) 425-6500
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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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: 2025-03-27
PECOS data refreshed: 2026-06-15
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
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 |
|---|---|---|---|---|
| I20180122000812 | I | Nurse Practitioner | IN | TBD |
| I20250327000265 | I | Nurse Practitioner | OH | 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 |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 76 | 62 | $0 |
Insurance plans in this area (ZIP 46845)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | NM | |
| - | IN | |
| Nurse Practitioner | IN | |
| - | IN | |
| - | IN | |
| Infectious Disease | IN | |
| Internal Medicine | IN | |
| - | IN | |
| - | IN | |
| O B S T E T R I C S/ G Y N E C O L O G Y | OR |
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