Unknown Individual – Medical Physician Assistant, NPI 1407856982
Medical Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,223 PHYSICIAN ASSISTANT in NV
Provider Addresses for Unknown Individual
2809 W Charleston Blvd Ste 150
Las Vegas, NV 891021998
Phone: (702) 476-9999
Type: Location
6990, Smoke Ranch Road, Las Vegas, Clark County, Nevada, 89128, United States
LAS VEGAS, NV 891283119
Phone: (702) 476-9999
Fax: (702) 946-1343
Type: Location
150, West Charleston Boulevard, 18b Arts District, Las Vegas, Clark County, Nevada, 89102, United States
LAS VEGAS, NV 891021998
Phone: (702) 476-9999
Fax: (702) 946-1343
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.
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 |
|---|---|---|---|---|
| I20091026000536 | I | Physician Assistant | NV | 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 |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 374 | 93 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 47 | 30 | $0 |
Insurance plans in this area (ZIP 89102)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| PHYSICIAN ASSISTANT | NV | 81002 | Urinalysis, manual test | 30 | 29 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | NV | |
| Pain Management | NV | |
| Pain Management | NV | |
| Interventional Pain Management, Anesthesiology | NV | |
| - | NV | |
| Nurse Practitioner | NV | |
| Physician Assistant | NV | |
| Physician Assistant | NV | |
| Pain Management | NV | |
| Interventional Pain Management, Physical Medicine And Rehabilitation | OH |
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