MASSACHUSETTS NEURODIAGNOSTICS, LLC – Physiological Laboratory, NPI 1063956555
Physiological Laboratory
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for MASSACHUSETTS NEURODIAGNOSTICS, LLC
4545 FULLER DR
SUITE 100
IRVING, TX 750386530
Phone: (469) 995-8416
Fax: (469) 680-3809
Type: Mailing
1500 DISTRICT AVE # 2053
BURLINGTON, MA 018035069
Phone: (617) 648-9854
Fax: (866) 279-4704
Type: Location
600 LAS COLINAS BLVD E STE 2000
IRVING, TX 750395607
Phone: (469) 995-8416
Fax: (469) 680-3809
Type: Mailing
99 ROSEWOOD DR STE 265
DANVERS, MA 019231300
Phone: (617) 648-9854
Fax: (866) 279-4704
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: 2017-11-24
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2024-05-31 (740 days ago).
Enrollment records
1
Earliest due date
2024-05-31
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 |
|---|---|---|---|---|
| O20171124000042 | O | Independent Diagnostic Testing Facility (Idtf) | MA | 2024-05-31 |
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 75038)
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