CHI Saint Joseph Medical Group – Family Medicine Physician, NPI 1104875970
Family Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for CHI Saint Joseph Medical Group
The Box, 4-6, Ram Place, Homerton, London Borough of Hackney, London, Greater London, England, E9 6LT, United Kingdom
LONDON, KY 407430936
Phone: (606) 330-7835
Fax: (606) 330-7825
Type: Mailing
1401, Harrodsburg Road, Headly Green, Lexington, Fayette County, Kentucky, 40504, United States
LEXINGTON, KY 405043751
Phone: (606) 330-7835
Fax: (606) 330-7825
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: 2025-11-19
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2024-06-30 (710 days ago).
Enrollment records
14
Earliest due date
2024-06-30
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 |
|---|---|---|---|---|
| O20031204000080 | O | Clinic/Group Practice | KY | 2024-06-30 |
| O20240423000704 | O | Clinic/Group Practice | TX | TBD |
| O20240502003345 | O | Clinic/Group Practice | GA | TBD |
| O20240516002961 | O | Clinic/Group Practice | OH | TBD |
| O20240523000030 | O | Clinic/Group Practice | DC | TBD |
| O20240530001141 | O | Clinic/Group Practice | CA | TBD |
| O20240530001448 | O | Clinic/Group Practice | OR | TBD |
| O20240609000102 | O | Clinic/Group Practice | OK | TBD |
| O20250628000347 | O | Clinic/Group Practice | NC | TBD |
| O20250630001366 | O | Clinic/Group Practice | TN | TBD |
| O20250811000110 | O | Clinic/Group Practice | FL | TBD |
| O20250818004586 | O | Clinic/Group Practice | PA | TBD |
| O20250923001251 | O | Clinic/Group Practice | MO | TBD |
| O20251119000187 | O | Clinic/Group Practice | IL | 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 40743)
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