SHAPREE SUMMERVILLE (PHD) – Clinical Psychologist, NPI 1578931572
Clinical Psychologist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,139 CLINICAL PSYCHOLOGIST in OH
Provider Addresses for SHAPREE SUMMERVILLE (PHD)
6545 MARKET AVE N STE 100
CANTON, OH 447212430
Phone: (937) 303-1209
Type: Location
5088 HEATHER WAY
HUBER HEIGHTS, OH 454248705
Phone: (937) 321-7648
Type: Mailing
3095 KETTERING BLVD
MORAINE, OH 454391983
Phone: (937) 293-8300
Type: Location
5425 FISHBURG RD
P.O. BOX 24111
HUBER HEIGHTS, OH 454247500
Phone:
Type: Mailing
5975 KENTSHIRE DR STE A
DAYTON, OH 454404254
Phone:
Type: Mailing
5975 Kentshire Dr Ste A
Dayton, OH 454404254
Phone: (937) 937-3138
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: 2025-12-29
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 |
|---|---|---|---|---|
| I20251229003313 | I | Clinical Psychologist | 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 44721)
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