THOMAS R FENNELL (MD) – Student in an Organized Health Care Education/Training Program, NPI 1386844405
Student in an Organized Health Care Education/Training Program
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
573 PATHOLOGY in MI
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Provider Addresses for THOMAS R FENNELL (MD)
Beaumont Health, 26901, Beaumont Boulevard, Southfield, Oakland County, Michigan, 48033, United States
SUITE 3D
SOUTHFIELD, MI 480333849
Phone: (947) 522-1861
Fax: (947) 522-0307
Type: Mailing
Beaumont Hospital - Royal Oak, 3601, West 13 Mile Road, Royal Oak, Oakland County, Michigan, 48073, United States
ROYAL OAK, MI 48073
Phone: (248) 423-2410
Fax: (248) 423-2576
Type: Location
1215 LEE ST # 800904
CHARLOTTESVILLE, VA 229080816
Phone: (434) 924-1946
Fax: (434) 982-1545
Type: Mailing
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: 2024-12-12
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
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 |
|---|---|---|---|---|
| I20240912002252 | I | Pathology | DC | TBD |
| I20241212000197 | I | Pathology | VA | 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 48033)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | VA | |
| P A T H O L O G Y | PA | |
| P A T H O L O G Y | VA | |
| P A T H O L O G Y | OK | |
| P A T H O L O G Y | TX | |
| P A T H O L O G Y | PA | |
| P A T H O L O G Y | RI | |
| - | MD | |
| P A T H O L O G Y | VA | |
| - | SC |
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