DR. DOUGLAS GREGORY TACKET (D.O.) – Family Medicine Physician, NPI 1790764868
Family Medicine Physician
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Profile Insights
NPPES metrics only — not quality of care.
4,418 FAMILY PRACTICE in MI
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Provider Addresses for DR. DOUGLAS GREGORY TACKET (D.O.)
4, Longmeadow Village Drive, Niles Charter Township, Berrien County, Michigan, 49120, United States
NILES, MI 491207809
Phone: (269) 684-6000
Fax: (269) 684-1388
Type: Mailing
206 W Warren St
Middlebury, IN 465409410
Phone: (574) 825-2146
Fax: (574) 524-7435
Type: Location
710 N NILES AVE
SOUTH BEND, IN 466171924
Phone: (574) 647-1610
Type: Mailing
206 W WARREN ST
MIDDLEBURY, IN 465409410
Phone: (574) 825-2146
Fax: (574) 524-7435
Type: Location
4077 S CLEVELAND AVE
SAINT JOSEPH, MI 490859513
Phone:
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 22 Open Payments records for all available years, with a total value of $581.
Total Amount is formed as General ($581) + Research ($0) + Ownership ($0) = $581.
Last reported payment date: 2024-12-18 • Largest payer in this snapshot: Astellas Pharma US Inc ($211).
Total Amount
$581
General + Research + Ownership
Payments
22
Total payment records
General Amount
$581
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-18
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Astellas Pharma US Inc | $211 |
| AstraZeneca Pharmaceuticals LP | $83 |
| Novo Nordisk Inc | $81 |
| Lilly USA, LLC | $47 |
| Exact Sciences Corporation | $33 |
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: 2004-01-05
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 |
|---|---|---|---|---|
| I20040105000462 | I | Family Practice | 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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 36415 | Insertion of needle into vein for collection of blood sample | 183 | 128 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 180 | 124 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 124 | 93 | $0 |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 100 | 100 | $0 |
| G0008 | Administration of influenza virus vaccine | 44 | 44 | $0 |
Insurance plans in this area (ZIP 49120)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | MI | |
| Nurse Practitioner | MI | |
| Nurse Practitioner | MI | |
| - | MI | |
| - | MI | |
| Physician Assistant | MI | |
| - | MI | |
| Physician Assistant | MI | |
| O B S T E T R I C S/ G Y N E C O L O G Y | MI | |
| Nurse Practitioner | MI |
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