Unknown Individual – Emergency Medical Services (Emergency Medicine) Physician, NPI 1255445904
Emergency Medical Services (Emergency Medicine) Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Unknown Individual
305 WARNER PL
SALINE, MI 481769110
Phone: (734) 944-4801
Type: Mailing
1013 E FERGUSON AVE
VISALIA, CA 932927202
Phone: (734) 277-6197
Type: Mailing
1050 N CHERRY ST
TULARE VA CLINIC
TULARE, CA 93274
Phone: (559) 684-8703
Fax: (559) 248-5329
Type: Location
Hillsdale Community Health Center, 168, South Howell Street, Hillsdale, Hillsdale Township, Hillsdale County, Michigan, 49242, United States
HILLSDALE COMMUNITY HEALTH CENTER
HILLSDALE, MI 492422040
Phone: (517) 437-4451
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 |
|---|---|---|---|---|
| I20061218000090 | I | Emergency Medicine | OH | 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 48176)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | OH |
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