FAN NY (CNP) – Gerontology Nurse Practitioner, NPI 1629414974
Gerontology Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
14,984 NURSE PRACTITIONER in OH
Provider Addresses for FAN NY (CNP)
701 TECH CENTER DR STE 250
GAHANNA, OH 432301987
Phone: (614) 944-4800
Fax: (614) 944-4750
Type: Mailing
PO BOX 636256
CINCINNATI, OH 452636256
Phone: (513) 585-6200
Fax: (513) 245-3672
Type: Mailing
3130 HIGHLAND AVE
CINCINNATI, OH 452192399
Phone: (513) 475-8500
Fax: (513) 584-4281
Type: Location
5150 CENTRE AVE STE 301
PITTSBURGH, PA 152321309
Phone: (878) 261-6344
Type: Mailing
701 Tech Center Dr
Gahanna, OH 432301987
Phone: (614) 396-2684
Fax: (614) 396-2480
Type: Location
620A Morrison Rd
Gahanna, OH 432305327
Phone: (614) 396-2684
Fax: (614) 396-2480
Type: Location
350 W Wilson Bridge Rd Ste 100
Worthington, OH 430852590
Phone: (614) 796-2900
Fax: (614) 796-2901
Type: Location
1030 Refugee Rd Ste 299
Pickerington, OH 431479755
Phone: (614) 396-2684
Fax: (614) 396-2480
Type: Location
701 TECH CENTER DR
GAHANNA, OH 432301987
Phone: (614) 396-2684
Fax: (614) 396-2480
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 3 Open Payments records for all available years, with a total value of $369.
Total Amount is formed as General ($369) + Research ($0) + Ownership ($0) = $369.
Last reported payment date: 2024-12-08 • Largest payer in this snapshot: Adaptive Biotechnologies Corporation ($251).
Total Amount
$369
General + Research + Ownership
Payments
3
Total payment records
General Amount
$369
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-08
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Adaptive Biotechnologies Corporation | $251 |
| Genmab U.S., Inc. | $118 |
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: 2014-03-25
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 |
|---|---|---|---|---|
| I20140325001332 | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 43230)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | OH | |
| Radiation Oncology | OH | |
| Certified Registered Nurse Anesthetist (Crna) | OH | |
| - | OH | |
| N E U R O L O G Y | OH | |
| - | OH | |
| - | OH | |
| - | OH | |
| - | OH | |
| Family Practice | OH |
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