FREDERICK CUSTOMEYEZ PROSTHETICS LLC – Prosthetic/Orthotic Supplier, NPI 1912440843
Prosthetic/Orthotic Supplier
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for FREDERICK CUSTOMEYEZ PROSTHETICS LLC
6005, Lafayette Drive, Granada Hills, Weldon Spring, Saint Charles County, Missouri, 63304, United States
WELDON SPRING, MO 633047890
Phone: (401) 584-3939
Type: Mailing
9278 PARADISE DR
PANAMA CITY BEACH, FL 324139625
Phone: (401) 584-3939
Fax: (216) 678-9186
Type: Mailing
1422, Euclid Avenue, East 4th Street, Playhouse Square, Cleveland, Cuyahoga County, Ohio, 44115, United States
SUITE 802
CLEVELAND, OH 441151902
Phone: (401) 584-3939
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: 2017-03-08
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
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 |
|---|---|---|---|---|
| O20170308000399 | O | Ocularist | 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 63304)
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