BROOKLYN PIERCE OTTO (PA-C) – Physician Assistant, NPI 1093591190
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
6,066 PHYSICIAN ASSISTANT in MI
Provider Addresses for BROOKLYN PIERCE OTTO (PA-C)
1445 Sheldon Rd Ste 200
Grand Haven, MI 494172479
Phone: (616) 296-9100
Type: Location
13411 Pineview Way Apt 204
Southgate, MI 481953436
Phone: (858) 437-7790
Type: Location
13411 PINEVIEW WAY APT 204
SOUTHGATE, MI 481953436
Phone:
Type: Mailing
1400 MERCY DR STE 100
MUSKEGON, MI 494441833
Phone: (231) 733-1326
Fax: (231) 733-5212
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.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2023-11-01
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 |
|---|---|---|---|---|
| I20231101001083 | I | Physician Assistant | MI | 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 49417)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| A N E S T H E S I O L O G Y | MI | |
| Physician Assistant | TX | |
| Physician Assistant | MI | |
| Orthopedic Surgery | MI | |
| Orthopedic Surgery | MI | |
| Physician Assistant | MI | |
| Physician Assistant | IL | |
| Orthopedic Surgery | MI | |
| Orthopedic Surgery | MN | |
| - | MI |
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