DOROTHY NICOLE LAKE (CPNP) – Pediatric Nurse Practitioner, NPI 1528438538
Pediatric Nurse Practitioner
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for DOROTHY NICOLE LAKE (CPNP)
4905 COURTNEY DR
FOREST PARK, GA 302971427
Phone: (404) 366-3636
Fax: (404) 362-0808
Type: Mailing
1561 S HIGHWAY 27
UNIT B6 & B7
CARROLLTON, GA 301178927
Phone: (404) 366-3636
Fax: (404) 362-0808
Type: Location
706 DIXIE ST STE 220
CARROLLTON, GA 301173889
Phone: (770) 812-8825
Type: Mailing
706 DIXIE ST STE 200
CARROLLTON, GA 301173889
Phone: (770) 812-8640
Fax: (770) 838-8650
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 5 Open Payments records for all available years, with a total value of $87.
Total Amount is formed as General ($87) + Research ($0) + Ownership ($0) = $87.
Last reported payment date: 2023-09-14 • Largest payer in this snapshot: PFIZER INC. ($35).
Total Amount
$87
General + Research + Ownership
Payments
5
Total payment records
General Amount
$87
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-09-14
Latest reported date
Top Companies
Largest payers in this snapshot
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: 2016-11-09
PECOS data refreshed: 2026-05-27
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 |
|---|---|---|---|---|
| I20161109001734 | 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 30297)
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