PAI PARTICIPANT 1 LLC – Geriatric Medicine (Internal Medicine) Physician, NPI 1093371312
Geriatric Medicine (Internal Medicine) Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for PAI PARTICIPANT 1 LLC
13755 Golf Club Pkwy
Fort Myers, FL 339195146
Phone: (239) 482-2848
Fax: (239) 482-7321
Type: Location
7700, York Road, Yorkleigh, Towson, Baltimore County, Maryland, 21204, United States
TOWSON, MD 212047513
Phone: (410) 821-5500
Type: Location
505 Couch Ave
Kirkwood, MO 631225577
Phone: (314) 909-6010
Type: Location
7700 York Rd
Towson, MD 212047513
Phone: (410) 821-5500
Type: Location
Boom Box Buns, 1324, Main Street, Main Street Business District, Over-the-Rhine, Cincinnati, Hamilton County, Ohio, 45202, United States
CINCINNATI, OH 452639676
Phone: (859) 291-4800
Fax: (859) 655-8588
Type: Mailing
60 MARIETTA RD
CHILLICOTHE, OH 456019433
Phone: (859) 291-4800
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: 2026-01-02
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2024-08-31 (647 days ago).
Enrollment records
15
Earliest due date
2024-08-31
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 |
|---|---|---|---|---|
| O20190611002122 | O | Clinic/Group Practice | MD | 2024-08-31 |
| O20200323002065 | O | Clinic/Group Practice | FL | 2026-04-30 |
| O20200331001591 | O | Clinic/Group Practice | KY | 2026-05-31 |
| O20200402000312 | O | Clinic/Group Practice | OH | 2026-06-30 |
| O20200403001264 | O | Clinic/Group Practice | TN | 2026-07-31 |
| O20200416000875 | O | Clinic/Group Practice | UT | 2026-08-31 |
| O20210503000979 | O | Clinic/Group Practice | MO | TBD |
| O20211208001934 | O | Clinic/Group Practice | VA | TBD |
| O20211213001706 | O | Clinic/Group Practice | VT | TBD |
| O20220613000044 | O | Clinic/Group Practice | NH | TBD |
| O20220719000230 | O | Clinic/Group Practice | ME | TBD |
| O20221103000005 | O | Clinic/Group Practice | DC | TBD |
| O20230106000629 | O | Clinic/Group Practice | MA | TBD |
| O20230801002991 | O | Clinic/Group Practice | AL | TBD |
| O20260102002839 | O | Clinic/Group Practice | DE | TBD |
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 33919)
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