AdventHealth Medical Group – Family Medicine Physician, NPI 1174955256
Family Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for AdventHealth Medical Group
12470 TELECOM DR STE 100
TEMPLE TERRACE, FL 33637
Phone: (838) 929-5449
Fax: (813) 929-5465
Type: Location
14055 RIVEREDGE DR STE 250
TAMPA, FL 336372141
Phone: (838) 929-5449
Fax: (813) 929-5465
Type: Location
3000 MEDICAL PARK DR
STE 320
TAMPA, FL 336134681
Phone: (813) 336-5766
Fax: (813) 971-1286
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: 2025-11-12
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 27 Medicare enrollment records; no due dates published yet.
Enrollment records
27
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 |
|---|---|---|---|---|
| O20131231000600 | O | Clinic/Group Practice | FL | TBD |
| O20250406000086 | O | Clinic/Group Practice | NC | TBD |
| O20250416000824 | O | Clinic/Group Practice | WI | TBD |
| O20250505000381 | O | Clinic/Group Practice | TX | TBD |
| O20250505000503 | O | Clinic/Group Practice | CO | TBD |
| O20250512000827 | O | Clinic/Group Practice | MI | TBD |
| O20250521002448 | O | Clinic/Group Practice | AK | TBD |
| O20250521002734 | O | Clinic/Group Practice | AZ | TBD |
| O20250521002951 | O | Clinic/Group Practice | VA | TBD |
| O20250521003192 | O | Clinic/Group Practice | CA | TBD |
| O20250521003453 | O | Clinic/Group Practice | NJ | TBD |
| O20250521003615 | O | Clinic/Group Practice | DC | TBD |
| O20250522002308 | O | Clinic/Group Practice | WA | TBD |
| O20250522002497 | O | Clinic/Group Practice | OR | TBD |
| O20250522002882 | O | Clinic/Group Practice | PA | TBD |
| O20250529002790 | O | Clinic/Group Practice | GA | TBD |
| O20250613001203 | O | Clinic/Group Practice | VT | TBD |
| O20250617001170 | O | Clinic/Group Practice | IL | TBD |
| O20250623001234 | O | Clinic/Group Practice | HI | TBD |
| O20250624003104 | O | Clinic/Group Practice | MN | TBD |
| O20250625000272 | O | Clinic/Group Practice | CT | TBD |
| O20250701000629 | O | Clinic/Group Practice | MD | TBD |
| O20250811001029 | O | Clinic/Group Practice | ME | TBD |
| O20251002001942 | O | Clinic/Group Practice | IN | TBD |
| O20251007003552 | O | Clinic/Group Practice | RI | TBD |
| O20251020000224 | O | Clinic/Group Practice | OH | TBD |
| O20251112002436 | O | Clinic/Group Practice | KY | 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 33637)
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