Unknown Individual – Nephrology Physician, NPI 1902804107
Nephrology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
458 NEPHROLOGY in MA
Provider Addresses for Unknown Individual
110 Liberty St
Brockton, MA 023015674
Phone: (508) 588-1505
Type: Location
830, Oak Street, Brockton, Plymouth County, Massachusetts, 02301, United States
125E
BROCKTON, MA 023011168
Phone: (508) 588-1505
Fax: (508) 588-1508
Type: Mailing
Oak Street, Brockton, Plymouth County, Massachusetts, 03201, United States
125E
BROCKTON, MA 023011168
Phone: (508) 588-1505
Fax: (508) 588-1508
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 280 Open Payments records for all available years, with a total value of $35,022.
Total Amount is formed as General ($35,022) + Research ($0) + Ownership ($0) = $35,022.
Last reported payment date: 2024-12-17 • Largest payer in this snapshot: ANI Pharmaceuticals, Inc. ($16,798).
Total Amount
$35,022
General + Research + Ownership
Payments
280
Total payment records
General Amount
$35,022
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-17
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ANI Pharmaceuticals, Inc. | $16,798 |
| Travere Therapeutics, Inc. | $7,539 |
| AstraZeneca Pharmaceuticals LP | $6,845 |
| Horizon Therapeutics plc | $883 |
| Daiichi Sankyo Inc. | $279 |
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: 2005-04-28
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 |
|---|---|---|---|---|
| I20050428000839 | I | Nephrology | MA | 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 |
|---|---|---|---|---|
| 90960 | Dialysis services, 4 or more physician visits per month (20 years or older) | 630 | 81 | $0 |
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | 438 | 194 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 430 | 230 | $0 |
| 90935 | Hemodialysis procedure with physician evaluation | 326 | 92 | $0 |
| 99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | 229 | 201 | $0 |
Insurance plans in this area (ZIP 02301)
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Provider's Procedures
Group practice members
| Name | Specialty | State |
|---|---|---|
| - | MA | |
| General Surgery | IL | |
| E N D O C R I N O L O G Y | MI | |
| - | CA | |
| Internal Medicine | MA | |
| - | NY | |
| O B S T E T R I C S/ G Y N E C O L O G Y | MA | |
| - | MA | |
| Orthopedic Surgery | MA | |
| - | NY |
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