My Heart Doctor – Cardiovascular Disease Physician, NPI 1174006159
Cardiovascular Disease Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for My Heart Doctor
1497 FAIR RD STE 311
STATESBORO, GA 304580828
Phone: (912) 243-9274
Fax: (912) 839-4575
Type: Mailing
1499 Fair Rd
Statesboro, GA 304581683
Phone: (912) 243-9274
Fax: (912) 341-6513
Type: Location
308 E Long St
Claxton, GA 304171412
Phone: (912) 243-9274
Fax: (912) 341-6513
Type: Location
4700 Waters Ave
Savannah, GA 314046220
Phone: (912) 243-9274
Fax: (912) 341-6513
Type: Location
1707 Meadows Ln Ste E-1
Vidalia, GA 304747200
Phone: (912) 243-9274
Fax: (912) 341-6513
Type: Location
1 Meadows Pkwy
Vidalia, GA 304748759
Phone: (912) 243-9274
Fax: (912) 341-6513
Type: Location
1058 Bermuda Run
Statesboro, GA 304580858
Phone: (912) 243-9274
Fax: (912) 341-6513
Type: Location
PO BOX 2027
STATESBORO, GA 304592027
Phone: (912) 243-9274
Fax: (912) 341-6513
Type: Mailing
1058 BERMUDA RUN
STATESBORO, GA 304580858
Phone: (912) 243-9274
Fax: (912) 341-6513
Type: Location
110 RUSHING LN
STATESBORO, GA 304586027
Phone: (912) 243-9274
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: 2018-10-16
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2023-10-31 (952 days ago).
Enrollment records
1
Earliest due date
2023-10-31
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 |
|---|---|---|---|---|
| O20181016003841 | O | Clinic/Group Practice | GA | 2023-10-31 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
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 30458)
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Reviews
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