DR. ANN JEAN DEBARTOLO (DO) – Surgery Physician, NPI 1063907798
Surgery Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,444 GENERAL SURGERY in MI
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Provider Addresses for DR. ANN JEAN DEBARTOLO (DO)
851 E 5TH ST STE 108
WASHINGTON, MO 630903128
Phone: (636) 861-7870
Type: Mailing
Metro Health Hospital, 5900, Byron Center Avenue Southwest, Wyoming, Kent County, Michigan, 49519, United States
WYOMING, MI 495199606
Phone: (616) 252-7635
Type: Location
901 Patients First Dr Ste 3200
Washington, MO 630904700
Phone: (636) 266-7930
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 2 Open Payments records for all available years, with a total value of $42.
Total Amount is formed as General ($42) + Research ($0) + Ownership ($0) = $42.
Last reported payment date: 2024-08-27 • Largest payer in this snapshot: Myriad Genetic Laboratories, Inc. ($23).
Total Amount
$42
General + Research + Ownership
Payments
2
Total payment records
General Amount
$42
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-08-27
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Myriad Genetic Laboratories, Inc. | $23 |
| Ethicon US, LLC | $19 |
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: 2023-09-18
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 |
|---|---|---|---|---|
| I20230918000253 | I | General Surgery | MO | 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 63090)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | MO | |
| - | MO | |
| - | MO | |
| General Surgery, Surgical Oncology | IL | |
| Orthopedic Surgery | CO | |
| - | MO | |
| Nurse Practitioner | MO | |
| Nurse Practitioner | MO | |
| General Surgery | MO | |
| N E U R O S U R G E R Y | MO |
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