DR. NICOLE MARIE REDDOUT (DMD) – Oral and Maxillofacial Surgery (Dentist), NPI 1790001436

DR. NICOLE MARIE REDDOUT (DMD) is a healthcare provider. based in Suffolk, Virginia. specializing in ORAL SURGERY, MAXILLOFACIAL SURGERY. They hold the professional credentials DMD. They hold a License No. 0438000368 (VA). The NPI Number for DR. NICOLE MARIE REDDOUT (DMD) is 1790001436

Main info

Female
16 Years Of Experience
Accepts Medicare Assignment
Name
DR. NICOLE MARIE REDDOUT (DMD)
NPI
1790001436
Phone
(702) 374-8217
Address
112 MERIDIAN PL
Enumeration Date
19 April 2010
Last Update Date
30 January 2017

Doctor Profile

Medical School Name
OTHER
Secondary Phone
5403625900
Graduation Year
2010 (16 years ago)
PAC ID
6800261652
Group Practice PAC ID
1456314681
Professional Enrollment ID
I20230407001127
Address ID
VA240194029RO6035XRDXX400
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience55
Completeness75
Years active:16State licenses:2Digital endpointsOther names

34 ORAL SURGERY in VA

Provider Addresses for DR. NICOLE MARIE REDDOUT (DMD)

  • 112 MERIDIAN PL

    SUFFOLK, VA 234353787

    Phone: (702) 374-8217

    Type: Mailing

  • 1647 ADMIRAL TAUSSIG BLVD

    NORFOLK, VA 235112803

    Phone: (757) 953-8605

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 8 Open Payments records for all available years, with a total value of $621.

Total Amount is formed as General ($621) + Research ($0) + Ownership ($0) = $621.

Last reported payment date: 2024-03-16 • Largest payer in this snapshot: Nobel Biocare USA ($377).

Total Amount

$621

General + Research + Ownership

Payments

8

Total payment records

General Amount

$621

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-03-16

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

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: 2023-04-07

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

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20230407001127IOral SurgeryVATBD

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.

Verify on CMS Revalidation Lookup Tool

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

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99202New patient office or other outpatient visit, 15-29 minutes3434$0
View full utilization report →

Insurance plans in this area (ZIP 23435)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 1456314681View full group profile
NameSpecialtyState
Oral SurgeryVA
Maxillofacial Surgery, DentistNC
Oral SurgeryMO

Reviews

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Frequently asked questions

How is DR. NICOLE MARIE REDDOUT (DMD) identified in CMS data?
CMS-hosted NPPES data lists DR. NICOLE MARIE REDDOUT (DMD) with NPI 1790001436.
Can I rely on DR. NICOLE MARIE REDDOUT (DMD) being an active provider?
As of the registry snapshot, DR. NICOLE MARIE REDDOUT (DMD) is marked active.
What taxonomy line describes DR. NICOLE MARIE REDDOUT (DMD)?
For research purposes, treat DR. NICOLE MARIE REDDOUT (DMD) as Oral and Maxillofacial Surgery (Dentist) in this dataset. Clinical services aligned with this taxonomy classification.
What address line appears for DR. NICOLE MARIE REDDOUT (DMD)?
DR. NICOLE MARIE REDDOUT (DMD)'s geographic hint is Suffolk, Virginia in our summary view.
Is the information about DR. NICOLE MARIE REDDOUT (DMD) up to date?
Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."

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