LAKE COUNTY PAIN & DIAGNOSTIC – Ambulatory Surgical Clinic/Center, NPI 1497740617
Ambulatory Surgical Clinic/Center
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for LAKE COUNTY PAIN & DIAGNOSTIC
Mentor Avenue, Midland Moor, The Reserves of Willoughby, Mentor, Lake County, Ohio, 44094, United States
STE A
MENTOR, OH 440605842
Phone: (440) 205-9119
Fax: (440) 205-9209
Type: Location
9485 MENTOR AVE STE 203
MENTOR, OH 440608723
Phone: (440) 205-9119
Fax: (440) 205-9209
Type: Mailing
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: 2004-05-04
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2024-04-30 (770 days ago).
Enrollment records
1
Earliest due date
2024-04-30
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 |
|---|---|---|---|---|
| O20040504000204 | O | Ambulatory Surgical Center | OH | 2024-04-30 |
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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 64483 | Injection of anesthetic and/or steroid drug into sacral spine nerve root using imaging guidance, single level | 356 | 182 | $0 |
| 62323 | Injection of substance into lower spine canal using imaging guidance | 83 | 67 | $0 |
| 64493 | Injection of lower or sacral spine facet joint using imaging guidance, single level | 56 | 35 | $0 |
| 20610 | Aspiration and/or injection of fluid from large joint | 34 | 26 | $0 |
| 64490 | Injection of upper or middle spine facet joint using imaging guidance, single level | 33 | 22 | $0 |
Insurance plans in this area (ZIP 44060)
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