SAMUEL VINCENT DISMUKE (PA-C) – Physician Assistant, NPI 1235631557
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
2,499 PHYSICIAN ASSISTANT in IN
Provider Addresses for SAMUEL VINCENT DISMUKE (PA-C)
1500 Provident Dr Ste B
Warsaw, IN 465803297
Phone: (574) 269-8301
Fax: (574) 269-8302
Type: Location
11136 Parkview Circle Dr
Fort Wayne, IN 468451730
Phone: (260) 484-8551
Fax: (260) 482-5060
Type: Location
7920 W Jefferson Blvd
Fort Wayne, IN 468044168
Phone: (260) 484-8551
Fax: (260) 482-5060
Type: Location
5052, North Clinton Street, Fort Wayne, Allen County, Indiana, 46825, United States
FORT WAYNE, IN 468255822
Phone: (260) 484-8551
Fax: (260) 482-5060
Type: Mailing
5050, North Clinton Street, Fort Wayne, Allen County, Indiana, 46825, United States
FORT WAYNE, IN 468255886
Phone: (260) 484-8551
Fax: (260) 482-5060
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
Loading prescription activity...
Open Payments (CMS)
CMS reports 13 Open Payments records for all available years, with a total value of $1,879.
Total Amount is formed as General ($1,879) + Research ($0) + Ownership ($0) = $1,879.
Last reported payment date: 2023-10-24 • Largest payer in this snapshot: SI-BONE, INC. ($1,390).
Total Amount
$1,879
General + Research + Ownership
Payments
13
Total payment records
General Amount
$1,879
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-10-24
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| SI-BONE, INC. | $1,390 |
| Camber Spine Technologies LLC | $409 |
| Globus Medical, Inc. | $80 |
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: 2018-05-04
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 |
|---|---|---|---|---|
| I20180504001206 | I | Physician Assistant | 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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 81 | 68 | $0 |
| 22614 | Fusion of additional segment of spine | 72 | 19 | $0 |
| 72100 | X-ray of lower and sacral spine, 2-3 views | 66 | 54 | $0 |
| 22853 | Insertion of cage or mesh device to spine bone and disc space during spine fusion | 46 | 25 | $0 |
| 99212 | Established patient office or other outpatient visit, 10-19 minutes | 43 | 36 | $0 |
Insurance plans in this area (ZIP 46580)
Loading plans...
Group practice members
| Name | Specialty | State |
|---|---|---|
| Orthopedic Surgery | IN | |
| Nurse Practitioner | IN | |
| - | IN | |
| Orthopedic Surgery | IN | |
| Family Practice, Orthopedic Surgery, Sports Medicine | IN | |
| Physician Assistant | IN | |
| Physician Assistant | IN | |
| Sports Medicine, Orthopedic Surgery | IN | |
| Physician Assistant | IN | |
| - | IN |
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.