TridentUSA Mobile Clinical Services, LLC – Nurse Practitioner, NPI 1942554837
Nurse Practitioner
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for TridentUSA Mobile Clinical Services, LLC
PO BOX 538420
ATLANTA, GA 303538420
Phone: (800) 940-0389
Fax: (866) 241-2815
Type: Mailing
930 RIDGEBROOK RD FL 3
SPARKS, MD 21152
Phone: (800) 940-0389
Fax: (866) 241-2815
Type: Location
4350 BROWNSBORO RD STE 210
LOUISVILLE, KY 402071681
Phone: (502) 244-2420
Fax: (502) 996-8282
Type: Location
12910 SHELBYVILLE RD STE 300
LOUISVILLE, KY 402432404
Phone: (502) 244-2420
Fax: (502) 996-8282
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: 2015-01-29
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 7 Medicare enrollment records; no due dates published yet.
Enrollment records
7
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 |
|---|---|---|---|---|
| O20130211000560 | O | Clinic/Group Practice | AL | TBD |
| O20130224000007 | O | Clinic/Group Practice | NC | TBD |
| O20130326000559 | O | Clinic/Group Practice | TN | TBD |
| O20140203001266 | O | Clinic/Group Practice | GA | TBD |
| O20140414000261 | O | Clinic/Group Practice | MD | TBD |
| O20140429000780 | O | Clinic/Group Practice | PA | TBD |
| O20150129001317 | O | Clinic/Group Practice | OH | 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 30353)
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