PORTAGE INTERNAL MEDICINE ASSOCIATES LLC – Geriatric Medicine (Internal Medicine) Physician, NPI 1083809784
Geriatric Medicine (Internal Medicine) Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Loading map...
Provider Addresses for PORTAGE INTERNAL MEDICINE ASSOCIATES LLC
101, 5th Street Southeast, Austin Estates, Barberton, Summit County, Ohio, 44203, United States
SUITE C
BARBERTON, OH 442034259
Phone: (330) 645-6463
Fax: (330) 645-6462
Type: Location
PO BOX 45519
WESTLAKE, OH 441450519
Phone: (800) 514-4390
Fax: (440) 808-3675
Type: Mailing
503 OVERLOOK DR
KENT, OH 442405824
Phone: (330) 645-6463
Fax: (330) 645-6462
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: 2007-11-08
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2024-07-31 (678 days ago).
Enrollment records
1
Earliest due date
2024-07-31
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 |
|---|---|---|---|---|
| O20071108000545 | O | Clinic/Group Practice | OH | 2024-07-31 |
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 44203)
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.