GREAT LAKES RADIOLOGY SERVICES – Diagnostic Radiology Physician, NPI 1891529111
Diagnostic Radiology Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for GREAT LAKES RADIOLOGY SERVICES
4501 Bruce B Downs BLVD
Wesley Chapel, FL 335449216
Phone: (813) 914-1000
Type: Location
729 W ANN ARBOR TRL STE 2
PLYMOUTH, MI 481706225
Phone: (734) 673-3764
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: 2026-02-26
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 16 Medicare enrollment records; no due dates published yet.
Enrollment records
16
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 |
|---|---|---|---|---|
| O20250124003035 | O | Clinic/Group Practice | MI | TBD |
| O20250402001415 | O | Clinic/Group Practice | OH | TBD |
| O20250403002791 | O | Clinic/Group Practice | UT | TBD |
| O20250425001510 | O | Clinic/Group Practice | CA | TBD |
| O20250429000189 | O | Clinic/Group Practice | IL | TBD |
| O20250507002696 | O | Clinic/Group Practice | PA | TBD |
| O20250515001227 | O | Clinic/Group Practice | AZ | TBD |
| O20250521000849 | O | Clinic/Group Practice | FL | TBD |
| O20250528002680 | O | Clinic/Group Practice | NY | TBD |
| O20250705000167 | O | Clinic/Group Practice | TX | TBD |
| O20250807000372 | O | Clinic/Group Practice | NH | TBD |
| O20250904003642 | O | Clinic/Group Practice | MO | TBD |
| O20251021000370 | O | Clinic/Group Practice | KS | TBD |
| O20251107001441 | O | Clinic/Group Practice | MA | TBD |
| O20251230003776 | O | Clinic/Group Practice | GA | TBD |
| O20260226004675 | O | Clinic/Group Practice | SC | 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 33544)
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