SHELLEY SMITH TICKETT – Pediatric Emergency Medicine (Emergency Medicine) Physician, NPI 1023064292
Pediatric Emergency Medicine (Emergency Medicine) Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for SHELLEY SMITH TICKETT
47 5TH ST NW
WINTER HAVEN, FL 338814672
Phone: (866) 234-8534
Fax: (863) 837-4469
Type: Mailing
305 W CENTRAL AVE
LAKE WALES, FL 338534015
Phone: (866) 234-8534
Fax: (863) 855-9737
Type: Location
14902 HERONGLEN DR
LITHIA, FL 335475887
Phone: (813) 317-1591
Type: Mailing
901 E BLOOMINGDALE AVE STE 501
BRANDON, FL 335118118
Phone: (813) 699-3995
Type: Location
Holiday Inn Express Tampa N I-75 - University Area, 13294, Telecom Drive, Tampa, Hillsborough County, Florida, 33637, United States
TAMPA, FL 336370913
Phone: (813) 972-4199
Fax: (813) 972-5753
Type: Mailing
East Fletcher Avenue, Tampa, Hillsborough County, Florida, 33592-2123, United States
TAMPA, FL 336134613
Phone: (813) 971-6000
Fax: (813) 615-7590
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 $13.
Total Amount is formed as General ($13) + Research ($0) + Ownership ($0) = $13.
Last reported payment date: 2023-07-28 • Largest payer in this snapshot: SOBI, INC ($13).
Total Amount
$13
General + Research + Ownership
Payments
1
Total payment records
General Amount
$13
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-07-28
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| SOBI, INC | $13 |
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: 2004-09-01
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 |
|---|---|---|---|---|
| I20040901001175 | I | Emergency Medicine | FL | 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 33881)
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Reviews
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