MBOUTIDEM ETOKAKPAN (MD) – Surgery Physician, NPI 1467851634
Surgery Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,601 GENERAL SURGERY in OH
Provider Addresses for MBOUTIDEM ETOKAKPAN (MD)
9 GALEN ST
WATERTOWN, MA 024724515
Phone:
Type: Mailing
1353 E MARKET ST
WARREN, OH 444836637
Phone: (310) 841-7130
Type: Location
2100 MACK BLVD FL 4
ALLENTOWN, PA 181035622
Phone: (570) 501-6368
Fax: (570) 501-4754
Type: Mailing
50 MOISEY DR
HAZLE TOWNSHIP, PA 182029297
Phone: (570) 501-6900
Fax: (570) 501-6945
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $21.
Total Amount is formed as General ($21) + Research ($0) + Ownership ($0) = $21.
Last reported payment date: 2023-11-21 • Largest payer in this snapshot: Salix Pharmaceuticals, a division of Bausch Health US, LLC ($21).
Total Amount
$21
General + Research + Ownership
Payments
1
Total payment records
General Amount
$21
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-11-21
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Salix Pharmaceuticals, a division of Bausch Health US, LLC | $21 |
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: 2022-08-13
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 3 Medicare enrollment records; no due dates published yet.
Enrollment records
3
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 |
|---|---|---|---|---|
| I20200701002971 | I | General Surgery | OH | TBD |
| I20220509002585 | I | General Surgery | VI | TBD |
| I20220813000831 | I | General Surgery | PA | 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 |
|---|---|---|---|---|
| 99203 | New patient office or other outpatient visit, 30-44 minutes | 70 | 70 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 63 | 47 | $0 |
| 99222 | Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes | 46 | 43 | $0 |
| 99231 | Subsequent hospital care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes | 43 | 29 | $0 |
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | 39 | 20 | $0 |
Insurance plans in this area (ZIP 02472)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | PA | |
| H O S P I T A L I S T | PA | |
| - | PA | |
| - | PA | |
| Internal Medicine | PA | |
| Family Practice | PA | |
| A N E S T H E S I O L O G Y | PA | |
| - | PA | |
| - | PA | |
| Orthopedic Surgery | PA |
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