SOUTHEASTERN PHYSICIAN SERVICES PC – Hospitalist Physician, NPI 1083835441
Hospitalist Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for SOUTHEASTERN PHYSICIAN SERVICES PC
PO BOX 635705
CINCINNATI, OH 452635705
Phone: (888) 203-1274
Type: Mailing
Methodist Medical Center of Oak Ridge, 990, Oak Ridge Turnpike, Jackson Square, Oak Ridge, Anderson County, Tennessee, 37831, United States
OAK RIDGE, TN 378306976
Phone: (865) 481-1000
Type: Location
1100 Brookhaven Rd
Franklin, KY 421342746
Phone: (270) 745-1212
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: 2016-08-31
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2023-08-31 (1012 days ago).
Enrollment records
5
Earliest due date
2023-08-31
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 |
|---|---|---|---|---|
| O20071025000571 | O | Clinic/Group Practice | TN | TBD |
| O20081229000558 | O | Clinic/Group Practice | VA | 2024-03-31 |
| O20090715000150 | O | Clinic/Group Practice | KY | TBD |
| O20160809000235 | O | Clinic/Group Practice | MO | 2023-08-31 |
| O20160831001321 | O | Clinic/Group Practice | MS | 2024-02-29 |
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 45263)
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