SOUTHEAST RADIOLOGY LTD – Diagnostic Radiology Physician, NPI 1790779684
Diagnostic Radiology Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for SOUTHEAST RADIOLOGY LTD
Evansville Post office, 402, Water Street, Evansville, Rock County, Wisconsin, 53536, United States
EVANSVILLE, IN 477313247
Phone: (800) 467-2392
Fax: (812) 471-6650
Type: Mailing
1 MEDICAL CENTER BLVD
CHESTER, PA 190133902
Phone: (610) 447-2517
Fax: (610) 956-0069
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: 2024-02-27
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2025-09-30 (248 days ago).
Enrollment records
12
Earliest due date
2025-09-30
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 |
|---|---|---|---|---|
| O20031210000107 | O | Clinic/Group Practice | PA | TBD |
| O20200131000628 | O | Clinic/Group Practice | GA | 2025-09-30 |
| O20200527002826 | O | Clinic/Group Practice | NC | 2025-10-31 |
| O20220304000243 | O | Clinic/Group Practice | CA | TBD |
| O20220926002188 | O | Clinic/Group Practice | OH | TBD |
| O20220930001697 | O | Clinic/Group Practice | NY | TBD |
| O20221004000606 | O | Clinic/Group Practice | AZ | TBD |
| O20221012000052 | O | Clinic/Group Practice | VA | TBD |
| O20221026000987 | O | Clinic/Group Practice | KY | TBD |
| O20221103001484 | O | Clinic/Group Practice | OR | TBD |
| O20221103002505 | O | Clinic/Group Practice | FL | TBD |
| O20240227001333 | O | Clinic/Group Practice | TX | 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 47731)
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