Specialized Rehabilitation Physician Group – Physical Medicine & Rehabilitation Physician, NPI 1053769661
Physical Medicine & Rehabilitation Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Specialized Rehabilitation Physician Group
13305 ROSELAND RD UNIT 755
ROSELAND, FL 329577031
Phone: (321) 206-1162
Fax: (772) 571-5722
Type: Mailing
410 Lionel Way Ste 202
Davenport, FL 338377809
Phone: (407) 499-0755
Fax: (949) 543-2564
Type: Location
1724 33rd St Ste 200
Orlando, FL 328398858
Phone: (407) 499-0755
Fax: (949) 543-2564
Type: Location
205 PARK PLACE BLVD STE A
KISSIMMEE, FL 347412345
Phone: (407) 499-0755
Fax: (949) 543-2564
Type: Location
5200 Davisson Ave Ste B
Orlando, FL 328105350
Phone: (407) 499-0755
Fax: (949) 543-2564
Type: Location
1804, Oakley Seaver Drive, Clermont, Lake County, Florida, 34711, United States
CLERMONT, FL 347111925
Phone: (407) 499-0755
Fax: (949) 543-2564
Type: Location
1804 OAKLEY SEAVER DR STE F
CLERMONT, FL 347111925
Phone: (407) 499-0755
Fax: (949) 543-2564
Type: Mailing
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: 2019-04-09
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2024-04-30 (770 days ago).
Enrollment records
2
Earliest due date
2024-04-30
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 |
|---|---|---|---|---|
| O20170510000924 | O | Clinic/Group Practice | FL | 2024-04-30 |
| O20190409000334 | O | Physician - Physical And Rehabilitation | FL | 2025-12-31 |
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 32957)
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