Grandview Hospital - Anesthesia – Anesthesiology Physician, NPI 1902097280
Anesthesiology Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Grandview Hospital - Anesthesia
3180, Kettering Boulevard, Moraine, Montgomery County, Ohio, 45439, United States
MORAINE, OH 454391924
Phone: (937) 297-6072
Fax: (937) 293-0969
Type: Mailing
Grandview Medical Center, 405, West Grand Avenue, Steeles Hill-Grafton Hill Historic District, Daytonview, Dayton, Montgomery County, Ohio, 45405, United States
DAYTON, OH 454054720
Phone: (937) 723-3200
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.
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Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2026-03-31 (69 days ago).
Enrollment records
1
Earliest due date
2026-03-31
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 |
|---|---|---|---|---|
| O20040120000374 | O | Clinic/Group Practice | OH | 2026-03-31 |
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 45439)
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