MARTY CAUDLE (PA) – Physician Assistant, NPI 1639318645
Physician Assistant
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Profile Insights
NPPES metrics only — not quality of care.
5,035 PHYSICIAN ASSISTANT in IL
Provider Addresses for MARTY CAUDLE (PA)
PO BOX 294
GARIBALDI, OR 971180294
Phone: (314) 974-1036
Type: Mailing
404 DURLEY ST
GREENVILLE, IL 62246
Phone: (618) 690-3595
Fax: (618) 690-3596
Type: Location
12860 Troxler Ave
Highland, IL 62249
Phone: (618) 651-2810
Fax: (618) 651-0077
Type: Location
102 Wessington Pl
Hendersonville, TN 370753085
Phone: (615) 822-2214
Type: Location
801, Pacific Avenue, Tillamook, Tillamook County, Oregon, 97141, United States
TILLAMOOK, OR 971413926
Phone: (503) 842-3900
Type: Location
127 CALDWELL DR
HENDERSONVILLE, TN 370752045
Phone: (503) 812-8611
Type: Mailing
102 WESSINGTON PL
HENDERSONVILLE, TN 370753085
Phone: (615) 822-2214
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 7 Open Payments records for all available years, with a total value of $127.
Total Amount is formed as General ($127) + Research ($0) + Ownership ($0) = $127.
Last reported payment date: 2024-07-03 • Largest payer in this snapshot: Novo Nordisk Inc ($47).
Total Amount
$127
General + Research + Ownership
Payments
7
Total payment records
General Amount
$127
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-07-03
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Novo Nordisk Inc | $47 |
| ABBVIE INC. | $34 |
| Valinor Pharma, LLC | $17 |
| Lilly USA, LLC | $16 |
| AstraZeneca Pharmaceuticals LP | $14 |
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: 2024-01-10
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
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 |
|---|---|---|---|---|
| I20090506000425 | I | Physician Assistant | OR | TBD |
| I20240110005063 | I | Physician Assistant | IL | 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 97118)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | IL | |
| Cardiovascular Disease (Cardiology), Internal Medicine | IL | |
| Cardiovascular Disease (Cardiology), Internal Medicine | IL | |
| Cardiovascular Disease (Cardiology), Internal Medicine | MO | |
| Nurse Practitioner | IL | |
| Cardiovascular Disease (Cardiology) | IL | |
| Family Practice | IL | |
| - | IL | |
| Internal Medicine, Cardiac Electrophysiology | MO | |
| Interventional Cardiology, Cardiovascular Disease (Cardiology), Internal Medicine | IL |
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