TRACY LYNN DETWILER (PAC) – Physician Assistant, NPI 1154490738
Physician Assistant
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Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
5,036 PHYSICIAN ASSISTANT in OH
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Provider Addresses for TRACY LYNN DETWILER (PAC)
212 E COLUMBUS AVE
BELLEFONTAINE, OH 433112033
Phone: (937) 599-1411
Fax: (937) 599-4128
Type: Mailing
South Park Avenue, West Liberty, Muscatine County, Iowa, 52776, United States
WEST LIBERTY, OH 433579525
Phone: (937) 599-1411
Fax: (937) 599-4128
Type: Mailing
East Columbus Avenue, Bellefontaine, Lake Township, Logan County, Ohio, 43311, United States
BELLEFONTAINE, OH 433112033
Phone: (937) 599-1411
Fax: (937) 599-4128
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: 2006-11-30
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 |
|---|---|---|---|---|
| I20061130000003 | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 43311)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | OH | |
| - | OH | |
| Nurse Practitioner | OH | |
| Nurse Practitioner | OH | |
| Family Practice | OH | |
| Nurse Practitioner | OH | |
| Nurse Practitioner | OH | |
| Nurse Practitioner | OH | |
| Family Practice | OH | |
| Family Practice | OH |
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