MR. ROOSEVELT HEZEKIAH WORTHAM-FLORENCE (NP) – Family Nurse Practitioner, NPI 1780132852
Family Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
14,984 NURSE PRACTITIONER in OH
Provider Addresses for MR. ROOSEVELT HEZEKIAH WORTHAM-FLORENCE (NP)
113 CLARETT CT
UNION, OH 453223545
Phone: (937) 321-0002
Type: Mailing
3420 ATRIUM BLVD STE 160
MIDDLETOWN, OH 450055186
Phone: (937) 321-0002
Fax: (937) 637-5251
Type: Mailing
Union Boulevard, Englewood, Montgomery County, Ohio, 45322, United States
APT 305
ENGLEWOOD, OH 453222126
Phone: (937) 301-7222
Type: Mailing
1800 DAYOH PL
DAYTON, OH 454174318
Phone: (937) 668-3097
Type: Mailing
6545 MARKET AVE N STE 100
CANTON, OH 447212430
Phone: (937) 516-3030
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
Loading prescription activity...
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: 2026-03-02
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 9 Medicare enrollment records; no due dates published yet.
Enrollment records
9
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 |
|---|---|---|---|---|
| I20220328002198 | I | Nurse Practitioner | OH | TBD |
| I20250424000865 | I | Nurse Practitioner | NE | TBD |
| I20260128003421 | I | Nurse Practitioner | AR | TBD |
| I20260128003648 | I | Nurse Practitioner | TX | TBD |
| I20260130002958 | I | Nurse Practitioner | NY | TBD |
| I20260130003079 | I | Nurse Practitioner | ME | TBD |
| I20260130003408 | I | Nurse Practitioner | KY | TBD |
| I20260204003179 | I | Nurse Practitioner | CA | TBD |
| I20260302000970 | I | Nurse Practitioner | MD | 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 45322)
Loading plans...
Reviews
All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.
No reviews yet. Be the first to share your experience — your opinion helps families compare providers.