AdventHealth Imaging – Diagnostic Radiology Physician, NPI 1740256494
Diagnostic Radiology Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for AdventHealth Imaging
775 PRIMERA BLVD STE 1031
LAKE MARY, FL 32746
Phone: (407) 333-9766
Fax: (407) 333-9782
Type: Location
900 HOPE WAY
ALTAMONTE SPRINGS, FL 327141502
Phone: (407) 200-2355
Fax: (407) 767-0608
Type: Mailing
960 RINEHART RD STE 1000
LAKE MARY, FL 327461561
Phone: (855) 241-2455
Type: Location
Winderley Place, Maitland, Orange County, Florida, 32810, United States
MAITLAND, FL 327514191
Phone: (407) 200-2355
Fax: (407) 767-0608
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: 2025-12-12
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 35 Medicare enrollment records; no due dates published yet.
Enrollment records
35
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 |
|---|---|---|---|---|
| O20211116001271 | O | Clinic/Group Practice | NJ | TBD |
| O20211124000938 | O | Clinic/Group Practice | IL | TBD |
| O20220510001779 | O | Clinic/Group Practice | AZ | TBD |
| O20220523001853 | O | Clinic/Group Practice | TX | TBD |
| O20220525002003 | O | Clinic/Group Practice | GA | TBD |
| O20220526002897 | O | Clinic/Group Practice | MI | TBD |
| O20220602001311 | O | Clinic/Group Practice | AL | TBD |
| O20220603001542 | O | Clinic/Group Practice | PA | TBD |
| O20220621003375 | O | Clinic/Group Practice | CO | TBD |
| O20220626000028 | O | Clinic/Group Practice | DC | TBD |
| O20220628000324 | O | Clinic/Group Practice | OH | TBD |
| O20220628001383 | O | Clinic/Group Practice | NY | TBD |
| O20220629003183 | O | Clinic/Group Practice | VT | TBD |
| O20220712001787 | O | Clinic/Group Practice | MO | TBD |
| O20220804001446 | O | Clinic/Group Practice | MA | TBD |
| O20221025001304 | O | Clinic/Group Practice | NC | TBD |
| O20221028000451 | O | Clinic/Group Practice | SC | TBD |
| O20221117000769 | O | Clinic/Group Practice | HI | TBD |
| O20221201001870 | O | Clinic/Group Practice | TN | TBD |
| O20230421000430 | O | Clinic/Group Practice | CA | TBD |
| O20230719002752 | O | Clinic/Group Practice | CT | TBD |
| O20231011001128 | O | Clinic/Group Practice | RI | TBD |
| O20240206004846 | O | Clinic/Group Practice | VA | TBD |
| O20240305000030 | O | Clinic/Group Practice | MD | TBD |
| O20240315002312 | O | Clinic/Group Practice | WA | TBD |
| O20240716000016 | O | Clinic/Group Practice | NV | TBD |
| O20240903000987 | O | Clinic/Group Practice | AK | TBD |
| O20240913000743 | O | Clinic/Group Practice | NM | TBD |
| O20241126004379 | O | Clinic/Group Practice | UT | TBD |
| O20250327002222 | O | Clinic/Group Practice | MN | TBD |
| O20250523000789 | O | Clinic/Group Practice | PR | TBD |
| O20250617001684 | O | Clinic/Group Practice | OR | TBD |
| O20250902000897 | O | Clinic/Group Practice | ME | TBD |
| O20251016003437 | O | Clinic/Group Practice | WI | TBD |
| O20251212001735 | O | Clinic/Group Practice | ID | 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 32746)
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