IMG MEDICAL GROUP DE PA – Sports Medicine (Family Medicine) Physician, NPI 1720708589
Sports Medicine (Family Medicine) Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for IMG MEDICAL GROUP DE PA
101 Convention Center Dr Ste 900
Las Vegas, NV 891092039
Phone: (781) 254-8837
Type: Location
1800 Pembrook Dr Ste 100
Orlando, FL 328106372
Phone: (888) 760-4266
Type: Location
201 Broad St Ste 420
Stamford, CT 069012004
Phone: (917) 334-9589
Type: Location
1045 Elm St Ste 204
Manchester, NH 031011844
Phone: (888) 760-4266
Type: Location
300 Baker Ave Ste 300
Concord, MA 017422124
Phone: (888) 760-4266
Fax: (203) 774-4636
Type: Location
325 N Saint Paul St Ste 3100
Dallas, TX 752013923
Phone: (888) 760-4266
Fax: (203) 774-4636
Type: Location
9005 Overlook Blvd
Brentwood, TN 370275269
Phone: (888) 760-4266
Type: Location
15333 N Pima Rd Ste 305
Scottsdale, AZ 852602717
Phone: (888) 760-4266
Fax: (203) 774-4636
Type: Location
201 BROAD ST STE 420
STAMFORD, CT 069012004
Phone: (917) 334-9589
Type: Location
244 N CONGRESS AVE # 2A
BOYNTON BEACH, FL 334264212
Phone: (888) 760-4266
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
Loading prescription activity...
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: 2025-09-29
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 8 Medicare enrollment records; no due dates published yet.
Enrollment records
8
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 |
|---|---|---|---|---|
| O20230714002106 | O | Clinic/Group Practice | FL | TBD |
| O20231017001492 | O | Clinic/Group Practice | AZ | TBD |
| O20231019001432 | O | Clinic/Group Practice | TN | TBD |
| O20231030002687 | O | Clinic/Group Practice | NH | TBD |
| O20240306004125 | O | Clinic/Group Practice | VA | TBD |
| O20240627000091 | O | Clinic/Group Practice | MD | TBD |
| O20240730001488 | O | Clinic/Group Practice | DC | TBD |
| O20250929003545 | O | Clinic/Group Practice | NV | 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 89109)
Loading plans...
Reviews
All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.
No reviews yet. Be the first to share your experience — your opinion helps families compare providers.