CCMMA CA PC – Critical Care Medicine (Anesthesiology) Physician, NPI 1679293443
Critical Care Medicine (Anesthesiology) Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for CCMMA CA PC
425 W 5th St
East Liverpool, OH 439202498
Phone: (330) 385-7200
Fax: (888) 220-6560
Type: Location
600 S Monroe St
Enid, OK 737017211
Phone: (580) 233-2300
Fax: (888) 220-6560
Type: Location
201 NW R D Mize Rd
Blue Springs, MO 640142513
Phone: (816) 228-5900
Fax: (888) 220-6560
Type: Location
1749 Sonoma Ave
Berkeley, CA 947072547
Phone: (845) 702-2711
Fax: (888) 220-6560
Type: Location
120 N Delaware St
Sandusky, MI 484711009
Phone: (810) 648-3770
Fax: (888) 220-6560
Type: Location
2 Park Ave Ste 2039
New York, NY 100165675
Phone: (845) 702-2711
Type: Location
129 N Washington St
Sumter, SC 291504949
Phone: (803) 774-9000
Fax: (888) 220-6560
Type: Location
6565 Fannin St
Houston, TX 770302703
Phone: (713) 790-3311
Fax: (888) 220-6560
Type: Location
350 Boulevard
Passaic, NJ 070552840
Phone: (973) 365-4300
Fax: (888) 220-6560
Type: Location
2 PARK AVE STE 2039
NEW YORK, NY 100165675
Phone:
Type: Mailing
PO BOX 631917
CINCINNATI, OH 452631917
Phone: (845) 702-2711
Type: Mailing
1100 BUTTE ST
REDDING, CA 960010852
Phone: (530) 244-5400
Fax: (888) 220-6560
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: 2022-11-29
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
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 |
|---|---|---|---|---|
| O20221028002534 | O | Clinic/Group Practice | CA | TBD |
| O20221129003540 | O | Clinic/Group Practice | TX | 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 43920)
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Reviews
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