TINA L VIDETIC (APRN, BC) – Nurse Practitioner, NPI 1396930707
Nurse Practitioner
Main info
Doctor Profile
Contacts
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for TINA L VIDETIC (APRN, BC)
1226 N 8TH ST
SHEBOYGAN, WI 530813404
Phone: (920) 678-7705
Type: Mailing
2414 KOHLER MEMORIAL DR
SHEBOYGAN, WI 530813129
Phone: (920) 457-4461
Type: Location
PO BOX 735044
CHICAGO, IL 606735044
Phone: (800) 326-2250
Type: Mailing
2600, Kiley Way, Plymouth, Sheboygan County, Wisconsin, 53073, United States
PLYMOUTH, WI 53073
Phone: (920) 457-4461
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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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: 2011-03-03
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
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20110303000961 | I | Nurse Practitioner | WI | 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 |
|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 38 | 35 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 33 | 28 | $0 |
| 93793 | Anticoagulant management of patient taking warfarin | 25 | 21 | $0 |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 23 | 23 | $0 |
| 85610 | Blood test, clotting time | 15 | 13 | $0 |
Insurance plans in this area (ZIP 53081)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | WI | |
| Family Practice | WI | |
| Family Practice | IL | |
| Geriatric Medicine, Internal Medicine | WI | |
| - | WI | |
| - | WI | |
| - | IL | |
| Family Practice | WI | |
| - | OH | |
| - | WI |
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