NI KETUT KUMALA DEWI HARIADI – Nurse Practitioner, NPI 1114404159
Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
14,984 NURSE PRACTITIONER in OH
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Provider Addresses for NI KETUT KUMALA DEWI HARIADI
9000, Moss Pointe Circle, Olmsted Township, Cuyahoga County, Ohio, 44138, United States
OLMSTED TWP, OH 441388168
Phone: (216) 258-3660
Type: Mailing
5001, Rockside Road, Independence, Cuyahoga County, Ohio, 44131, United States
INDEPENDENCE, OH 441312172
Phone: (216) 986-4000
Type: Location
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: 2018-11-28
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 |
|---|---|---|---|---|
| I20181128003475 | I | Nurse Practitioner | OH | 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 | 400 | 266 | $0 |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 70 | 70 | $0 |
| G0444 | Annual depression screening, 5 to 15 minutes | 50 | 50 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 42 | 40 | $0 |
| 99212 | Established patient office or other outpatient visit, 10-19 minutes | 13 | 12 | $0 |
Insurance plans in this area (ZIP 44138)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | NV | |
| Nephrology, Internal Medicine | OH | |
| - | OH | |
| - | MI | |
| Nurse Practitioner | OH | |
| General Surgery, Anesthesiology, Critical Care (Intensivists) | OH | |
| Certified Registered Nurse Anesthetist (Crna) | OH | |
| - | OH | |
| - | MN | |
| Nurse Practitioner | OH |
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