MR. WILLARD KEITH III CUPP (PMHNP) – Psychiatric/Mental Health Nurse Practitioner, NPI 1265021406
Psychiatric/Mental Health Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
8,191 NURSE PRACTITIONER in IN
Provider Addresses for MR. WILLARD KEITH III CUPP (PMHNP)
236 SIMPSON AVE
ELKHART, IN 465164666
Phone: (574) 968-2461
Type: Mailing
3688 W HUNTINGTON AVE-57
COLUMBIA CITY, IN 467259434
Phone: (260) 508-0690
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 27 Open Payments records for all available years, with a total value of $493.
Total Amount is formed as General ($493) + Research ($0) + Ownership ($0) = $493.
Last reported payment date: 2024-12-19 • Largest payer in this snapshot: ABBVIE INC. ($193).
Total Amount
$493
General + Research + Ownership
Payments
27
Total payment records
General Amount
$493
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-19
Latest reported date
Top Companies
Largest payers in this snapshot
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: 2021-02-02
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 |
|---|---|---|---|---|
| I20210202001233 | I | Nurse Practitioner | 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 46516)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | IN | |
| Mental Health Counselor | MI | |
| Internal Medicine | IN | |
| Nurse Practitioner | IN | |
| Nurse Practitioner | IN | |
| Family Practice | IN | |
| O B S T E T R I C S/ G Y N E C O L O G Y | MI | |
| - | IN | |
| Clinical Social Worker | MI | |
| Nurse Practitioner | IN |
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