Unknown Individual – Emergency Medicine Physician, NPI 1083663769
Emergency Medicine Physician
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Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
Box Circle, Victory Villa, Middle River, Baltimore County, Maryland, 21221, United States
BALTIMORE, MD 212758952
Phone: (804) 968-5700
Type: Mailing
630, Mantua Pike, Woodbury, Gloucester County, New Jersey, 08096, United States
WOODBURY, NJ 080963233
Phone: (856) 812-2220
Fax: (856) 812-2221
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.
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 |
|---|---|---|---|---|
| I20150828001006 | I | Emergency Medicine | NJ | 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 21275)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| EMERGENCY MEDICINE | NJ | 81002 | Urinalysis, manual test | 17 | 16 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| - | NJ | |
| Advanced Heart Failure And Transplant Cardiology | MD | |
| - | NJ | |
| - | NJ | |
| G A S T R O E N T E R O L O G Y | NJ | |
| Clinical Psychologist | NJ | |
| - | NJ | |
| Nurse Practitioner | NJ | |
| Nurse Practitioner | NJ | |
| Osteopathic Manipulative Medicine, Family Practice | NJ |
Reviews
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