VIRTU30 TELEHEALTH SERVICES CORP – Primary Care Nurse Practitioner, NPI 1174147193
Primary Care Nurse Practitioner
Main info
Contacts
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for VIRTU30 TELEHEALTH SERVICES CORP
1540 16TH ST NE
NAPLES, FL 341203447
Phone: (317) 697-9296
Type: Mailing
6436 S JOHN BUTLER RD
COLUMBUS, IN 472019437
Phone: (877) 298-2079
Type: Location
1540 16th St NE
Naples, FL 341203447
Phone: (317) 697-9296
Type: Location
11870 Sunrise Valley Dr
Reston, VA 201913304
Phone: (877) 298-2076
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: 2023-10-12
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Revalidation due soon
Earliest CMS due date is 2026-06-30 (23 days away).
Enrollment records
3
Earliest due date
2026-06-30
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 |
|---|---|---|---|---|
| O20200710000336 | O | Clinic/Group Practice | FL | 2026-06-30 |
| O20230911001251 | O | Clinic/Group Practice | IN | TBD |
| O20231012003408 | O | Clinic/Group Practice | DC | TBD |
What to do next
- Confirm the due date on the CMS Revalidation Lookup Tool.
- Complete revalidation in PECOS before the published due date.
- If you have multiple enrollment records, revalidate each one on its own schedule.
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 34120)
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