DR. JEFFREY CARL PENCE (MD) – Pediatric Surgery Physician, NPI 1629063722
Pediatric Surgery Physician
Main info
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Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for DR. JEFFREY CARL PENCE (MD)
Dayton Children’s Hospital, 1, Childrens Plaza, Dayton, Montgomery County, Ohio, 45414, United States
DAYTON, OH 454041815
Phone: (937) 461-3000
Type: Mailing
3333 W Tech Rd
Miamisburg, OH 453420955
Phone: (937) 641-4000
Fax: (937) 641-4500
Type: Location
1 Childrens Plz
Dayton, OH 454041815
Phone: (937) 641-4000
Fax: (937) 641-4500
Type: Location
4348 Electric Rd
Roanoke, VA 240180720
Phone: (540) 769-0976
Fax: (540) 857-5383
Type: Location
175 WHITE ST NW STE 200
MARIETTA, GA 300607901
Phone: (943) 202-7820
Type: Location
213 S JEFFERSON ST STE 1006
ROANOKE, VA 240111713
Phone: (540) 224-5352
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: 2023-06-06
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 3 Medicare enrollment records; no due dates published yet.
Enrollment records
3
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 |
|---|---|---|---|---|
| I20210126002500 | I | General Surgery | ME | TBD |
| I20230316002811 | I | General Surgery | VA | TBD |
| I20230606002441 | I | General Surgery | IA | 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 45404)
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