MACKENZIE R TIDERINGTON (P.A-C) – Physician Assistant, NPI 1114577103
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
5,032 PHYSICIAN ASSISTANT in OH
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Provider Addresses for MACKENZIE R TIDERINGTON (P.A-C)
110, Wilmington Pike, Walnut Hills, Dayton, Montgomery County, Ohio, 45420, United States
DAYTON, OH 454597021
Phone: (937) 848-4121
Fax: (937) 848-5965
Type: Mailing
6551 CENTERVILLE BUSINESS PKWY STE 120
CENTERVILLE, OH 454592696
Phone: (937) 415-9100
Fax: (937) 415-9191
Type: Mailing
4160 LITTLE YORK RD STE 10
DAYTON, OH 454145803
Phone: (937) 415-9100
Fax: (937) 415-9191
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 121 Open Payments records for all available years, with a total value of $6,500.
Total Amount is formed as General ($6,500) + Research ($0) + Ownership ($0) = $6,500.
Last reported payment date: 2024-11-29 • Largest payer in this snapshot: Abbott Laboratories ($1,758).
Total Amount
$6,500
General + Research + Ownership
Payments
121
Total payment records
General Amount
$6,500
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-29
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Abbott Laboratories | $1,758 |
| Boston Scientific Corporation | $1,612 |
| Curonix LLC | $1,490 |
| Medtronic, Inc. | $1,236 |
| Vertos Medical, Inc. | $335 |
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: 2019-11-25
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 |
|---|---|---|---|---|
| I20191125001735 | I | Physician Assistant | 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 |
|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 432 | 307 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 283 | 204 | $0 |
| 20553 | Injection of trigger points, 3 or more muscles | 21 | 17 | $0 |
| 99203 | New patient office or other outpatient visit, 30-44 minutes | 17 | 17 | $0 |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 11 | 11 | $0 |
Insurance plans in this area (ZIP 45459)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | OH | |
| Physician Assistant | OH | |
| Orthopedic Surgery, Sports Medicine | OH | |
| Physician Assistant | OH | |
| Physician Assistant | OH | |
| Physician Assistant | OH | |
| Orthopedic Surgery | OH | |
| Occupational Therapist In Private Practice | OH | |
| Orthopedic Surgery | OH | |
| Physical Therapist In Private Practice | OH |
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