SHONTIAYA S. PATTERSON (FNP) – Family Nurse Practitioner, NPI 1063762870
Family Nurse Practitioner
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for SHONTIAYA S. PATTERSON (FNP)
175 GWINNETT DR
LAWRENCEVILLE, GA 300468444
Phone: (770) 339-2395
Fax: (678) 990-3997
Type: Location
141 WATKINS GLEN DR
MCDONOUGH, GA 302524061
Phone: (770) 309-8302
Type: Mailing
1324 HIGHWAY 138 SW
RIVERDALE, GA 302961404
Phone: (770) 907-4949
Fax: (770) 907-4022
Type: Location
175 Gwinnett Dr
Lawrenceville, GA 300468444
Phone: (770) 339-2395
Fax: (678) 990-3997
Type: Location
559 Flat Shoals Ave SE
Atlanta, GA 303162027
Phone: (770) 907-4949
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 2 Open Payments records for all available years, with a total value of $142.
Total Amount is formed as General ($142) + Research ($0) + Ownership ($0) = $142.
Last reported payment date: 2024-11-20 • Largest payer in this snapshot: Otsuka America Pharmaceutical, Inc. ($127).
Total Amount
$142
General + Research + Ownership
Payments
2
Total payment records
General Amount
$142
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-20
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Otsuka America Pharmaceutical, Inc. | $127 |
| Astellas Pharma US Inc | $15 |
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: 2021-01-29
PECOS data refreshed: 2026-06-15
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
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 |
|---|---|---|---|---|
| I20210129001627 | I | Nurse Practitioner | GA | 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 30046)
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