Integrative Pain and Psych Care – Family Nurse Practitioner, NPI 1609382134
Family Nurse Practitioner
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Integrative Pain and Psych Care
228 Meadow St # 402
Waterbury, CT 067021807
Phone: (203) 693-1164
Fax: (203) 446-5599
Type: Location
1060, South Jones Boulevard, Charleston Heights, Las Vegas, Clark County, Nevada, 89107, United States
LAS VEGAS, NV 891072623
Phone: (203) 693-1164
Fax: (888) 475-7210
Type: Mailing
205, Straits Turnpike, Bradleyville, Middlebury, New Haven County, Connecticut, 06762, United States
MIDDLEBURY, CT 067622800
Phone: (203) 693-1164
Fax: (888) 475-7210
Type: Location
1 BRADLEY RD STE 505
WOODBRIDGE, CT 065252292
Phone: (203) 693-1164
Fax: (203) 446-5599
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: 2018-01-24
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2024-05-31 (744 days ago).
Enrollment records
1
Earliest due date
2024-05-31
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 |
|---|---|---|---|---|
| O20180124001410 | O | Clinic/Group Practice | CT | 2024-05-31 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
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 06702)
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