SMB RADIOLOGY P A – Diagnostic Radiology Physician, NPI 1609877356
Diagnostic Radiology Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for SMB RADIOLOGY P A
PO BOX 749627
ATLANTA, GA 303749627
Phone: (866) 264-3435
Fax: (706) 596-6704
Type: Mailing
4320, 15th Street, Gulfport, Harrison County, Mississippi, 39501, United States
SUITE A
GULFPORT, MS 395012524
Phone: (228) 864-4392
Fax: (228) 868-7103
Type: Location
1365 MARKET ST
PASCAGOULA, MS 395676604
Phone: (228) 762-1353
Fax: (228) 762-1359
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: 2025-09-02
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 8 Medicare enrollment records; no due dates published yet.
Enrollment records
8
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 |
|---|---|---|---|---|
| O20061108000496 | O | Clinic/Group Practice | MS | TBD |
| O20221020000222 | O | Clinic/Group Practice | AL | TBD |
| O20221220000297 | O | Clinic/Group Practice | FL | TBD |
| O20241202003266 | O | Clinic/Group Practice | TN | TBD |
| O20250117002366 | O | Clinic/Group Practice | CA | TBD |
| O20250224000290 | O | Clinic/Group Practice | NY | TBD |
| O20250226004021 | O | Clinic/Group Practice | LA | TBD |
| O20250902001493 | O | Clinic/Group Practice | KY | 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 30374)
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