JIDEOFOR KENECHI NDULUE (MD) – Student in an Organized Health Care Education/Training Program, NPI 1861021636
Student in an Organized Health Care Education/Training Program
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
4,141 FAMILY PRACTICE in WA
Provider Addresses for JIDEOFOR KENECHI NDULUE (MD)
931 S Market Blvd
Chehalis, WA 985323423
Phone: (360) 767-6305
Type: Location
602 MALIBU DR SE
LACEY, WA 985031366
Phone:
Type: Mailing
931 S MARKET BLVD
CHEHALIS, WA 985323423
Phone: (360) 767-6305
Type: Location
500 PORTER AVE
AURORA, MO 656052365
Phone: (417) 678-7888
Type: Mailing
3 Saint Elizabeth Blvd Ste 4000
O Fallon, IL 622691284
Phone: (618) 233-5480
Fax: (618) 222-4790
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 $17.
Total Amount is formed as General ($17) + Research ($0) + Ownership ($0) = $17.
Last reported payment date: 2023-04-10 • Largest payer in this snapshot: kaleo, Inc. ($17).
Total Amount
$17
General + Research + Ownership
Payments
1
Total payment records
General Amount
$17
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-04-10
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| kaleo, Inc. | $17 |
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: 2024-09-24
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 3 Medicare enrollment records; no due dates published yet.
Enrollment records
3
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 |
|---|---|---|---|---|
| I20230919000203 | I | Family Practice | MO | TBD |
| I20231201000362 | I | Family Practice | NC | TBD |
| I20240924002118 | I | Emergency Medicine | 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 98532)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Emergency Medicine | IL | |
| Emergency Medicine | LA | |
| Family Practice | IL | |
| - | IL | |
| Internal Medicine, Preventive Medicine, Emergency Medicine | IL | |
| Internal Medicine, Emergency Medicine | IL | |
| Emergency Medicine, Internal Medicine | IL | |
| - | TX | |
| - | MD | |
| Family Practice | IL |
Reviews
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