Unknown Individual – Critical Care Medicine (Internal Medicine) Physician, NPI 1386617389
Critical Care Medicine (Internal Medicine) Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Unknown Individual
2533 NOTTINGHAM RD SE
ROANOKE, VA 240143409
Phone: (757) 377-1466
Type: Location
Portsmouth Post Office, Heritage Avenue, Maplehaven, Portsmouth, Rockingham County, New Hampshire, 03801, United States
PORTSMOUTH, VA 237070068
Phone: (757) 686-3516
Fax: (757) 686-0230
Type: Mailing
Virginia Beach Psychiatric Center, 1060, First Colonial Road, Linkhorn, Virginia Beach, Virginia, 23454, United States
TIDEWATER INTEGRATED MEDICAL SERVICES PLLC
VIRGINIA BEACH, VA 234543002
Phone: (757) 967-8622
Fax: (757) 686-0541
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $57.
Total Amount is formed as General ($57) + Research ($0) + Ownership ($0) = $57.
Last reported payment date: 2023-04-12 • Largest payer in this snapshot: Potrero Medical, Inc. ($57).
Total Amount
$57
General + Research + Ownership
Payments
1
Total payment records
General Amount
$57
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-04-12
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Potrero Medical, Inc. | $57 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 4 Medicare enrollment records; no due dates published yet.
Enrollment records
4
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 |
|---|---|---|---|---|
| I20100803001167 | I | Critical Care (Intensivists) | VA | TBD |
| I20180221001638 | I | Hospitalist | SC | TBD |
| I20230913003337 | I | Critical Care (Intensivists) | NC | TBD |
| I20250416002381 | I | Critical Care (Intensivists) | GU | 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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99291 | Critical care, first 30-74 minutes | 31 | 14 | $0 |
Insurance plans in this area (ZIP 24014)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| O B S T E T R I C S/ G Y N E C O L O G Y | CT | |
| Physician Assistant | CT | |
| Family Practice | CT | |
| Physician Assistant | CT | |
| P S Y C H I A T R Y | CT | |
| O B S T E T R I C S/ G Y N E C O L O G Y | CT | |
| O B S T E T R I C S/ G Y N E C O L O G Y | CT | |
| Physician Assistant | CT | |
| Internal Medicine | NY | |
| Nurse Practitioner | CT |
Reviews
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