Unknown Individual – Medical Physician Assistant, NPI 1295789170
Medical Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
Pompton Avenue, Cedar Grove, Bowes, Elgin, Plato Township, Kane County, Illinois, 60124, United States
CEDAR GROVE, NJ 070091820
Phone: (973) 239-2300
Mailing address matches the actual address.
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 |
|---|---|---|---|---|
| I20060317000011 | I | Physician Assistant | NJ | 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 | 146 | 129 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 102 | 90 | $0 |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 84 | 84 | $0 |
| 87880 | Detection test by immunoassay with direct visual observation for streptococcus, group a (strep) | 38 | 38 | $0 |
| 99203 | New patient office or other outpatient visit, 30-44 minutes | 32 | 32 | $0 |
Insurance plans in this area (ZIP 07009)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | GA | |
| Physician Assistant | NJ | |
| - | NJ | |
| Physician Assistant | FL | |
| Nurse Practitioner | NJ | |
| Family Practice | NJ | |
| Physician Assistant | NJ | |
| Nurse Practitioner | NJ | |
| - | NJ | |
| - | NJ |
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