SUMMIT RADIOLOGY P C – Diagnostic Radiology Physician, NPI 1073584587
Diagnostic Radiology Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for SUMMIT RADIOLOGY P C
PO BOX 80070
SUMMIT RADIOLOGY PC
FORT WAYNE, IN 468980070
Phone: (260) 432-1568
Fax: (260) 432-4969
Type: Mailing
5001 US HIGHWAY 30 W STE D
SUMMIT RADIOLOGY PC
FORT WAYNE, IN 468189701
Phone: (260) 432-1568
Fax: (260) 432-4969
Type: Location
7221 ENGLE RD STE 220
FORT WAYNE, IN 468042233
Phone: (260) 432-1568
Fax: (260) 432-4969
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: 2025-11-05
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2024-03-31 (804 days ago).
Enrollment records
28
Earliest due date
2024-03-31
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 |
|---|---|---|---|---|
| O20040831000152 | O | Clinic/Group Practice | IN | TBD |
| O20081222000511 | O | Clinic/Group Practice | MI | TBD |
| O20091030000231 | O | Clinic/Group Practice | CO | TBD |
| O20091120000176 | O | Clinic/Group Practice | NV | TBD |
| O20091228000171 | O | Clinic/Group Practice | HI | TBD |
| O20100128000271 | O | Clinic/Group Practice | CA | TBD |
| O20131015000792 | O | Clinic/Group Practice | OH | TBD |
| O20150112000207 | O | Clinic/Group Practice | TN | 2024-03-31 |
| O20151113000741 | O | Clinic/Group Practice | NJ | TBD |
| O20160909001921 | O | Clinic/Group Practice | KY | TBD |
| O20190903000946 | O | Clinic/Group Practice | NC | 2024-09-30 |
| O20200220002340 | O | Clinic/Group Practice | TX | 2025-10-31 |
| O20200702000137 | O | Clinic/Group Practice | PA | 2026-01-31 |
| O20200707000577 | O | Clinic/Group Practice | GA | TBD |
| O20200709001879 | O | Clinic/Group Practice | FL | 2026-06-30 |
| O20200713002256 | O | Clinic/Group Practice | WA | 2026-07-31 |
| O20200716002197 | O | Clinic/Group Practice | AZ | 2026-07-31 |
| O20200910002308 | O | Clinic/Group Practice | NY | 2026-08-31 |
| O20201104000226 | O | Clinic/Group Practice | MA | 2026-09-30 |
| O20210504001840 | O | Clinic/Group Practice | MD | 2026-10-31 |
| O20220502000388 | O | Clinic/Group Practice | AL | TBD |
| O20220511001841 | O | Clinic/Group Practice | IA | TBD |
| O20220512001223 | O | Clinic/Group Practice | MO | TBD |
| O20230620000989 | O | Clinic/Group Practice | IL | TBD |
| O20230731003203 | O | Clinic/Group Practice | SC | TBD |
| O20240214001339 | O | Clinic/Group Practice | VA | TBD |
| O20251023002867 | O | Clinic/Group Practice | ID | TBD |
| O20251105001451 | O | Clinic/Group Practice | MN | TBD |
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 46898)
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