HERODINA IBANEZ LU (PA-C) – Physician Assistant, NPI 1720542509
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
5,036 PHYSICIAN ASSISTANT in OH
Provider Addresses for HERODINA IBANEZ LU (PA-C)
428 WINDSOR PARK DR
CENTERVILLE, OH 454594111
Phone: (937) 829-7562
Type: Mailing
1 ELIZABETH PL NWB STE 15
DAYTON, OH 454173445
Phone: (937) 813-4404
Fax: (937) 938-9131
Type: Location
960 HEATHSHIRE DR
CENTERVILLE, OH 454592320
Phone:
Type: Mailing
1 ELIZABETH PL STE 100
DAYTON, OH 454173445
Phone: (937) 723-7230
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: 2020-01-08
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 |
|---|---|---|---|---|
| I20200108003059 | 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 45459)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | OH | |
| Internal Medicine, Pediatric Medicine | OH | |
| Nurse Practitioner | OH | |
| Nurse Practitioner | OH | |
| - | OH | |
| Nurse Practitioner | OH |
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