MIRA MACE MEDICAL GROUP PA – Family Medicine Physician, NPI 1487532289
Family Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for MIRA MACE MEDICAL GROUP PA
1111B S GOVERNORS AVE STE 39475
DOVER, DE 199046903
Phone:
Type: Mailing
11810 GRAND PARK AVE STE 500
NORTH BETHESDA, MD 208528679
Phone: (332) 296-0021
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: 2026-03-10
PECOS data refreshed: 2026-06-15
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 19 Medicare enrollment records; no due dates published yet.
Enrollment records
19
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 |
|---|---|---|---|---|
| O20251119001523 | O | Clinic/Group Practice | MA | TBD |
| O20251202001616 | O | Clinic/Group Practice | TX | TBD |
| O20251203000181 | O | Clinic/Group Practice | GA | TBD |
| O20251204000189 | O | Clinic/Group Practice | NH | TBD |
| O20251204000845 | O | Clinic/Group Practice | FL | TBD |
| O20251209003098 | O | Clinic/Group Practice | CO | TBD |
| O20251209003209 | O | Clinic/Group Practice | WA | TBD |
| O20251217001558 | O | Clinic/Group Practice | IL | TBD |
| O20251218001392 | O | Clinic/Group Practice | IN | TBD |
| O20251218004418 | O | Clinic/Group Practice | PA | TBD |
| O20251219002101 | O | Clinic/Group Practice | DC | TBD |
| O20251219003684 | O | Clinic/Group Practice | MO | TBD |
| O20251223000353 | O | Clinic/Group Practice | OH | TBD |
| O20260105001082 | O | Clinic/Group Practice | MN | TBD |
| O20260107000068 | O | Clinic/Group Practice | SC | TBD |
| O20260108001780 | O | Clinic/Group Practice | OK | TBD |
| O20260122003993 | O | Clinic/Group Practice | TN | TBD |
| O20260218000214 | O | Clinic/Group Practice | NC | TBD |
| O20260310002648 | O | Clinic/Group Practice | MD | 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 19904)
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