Omega Rehabilitation and Spine – Pain Medicine (Physical Medicine & Rehabilitation) Physician, NPI 1174956106
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Omega Rehabilitation and Spine
515 W SOUTHLAKE BLVD STE 100
SOUTHLAKE, TX 760926172
Phone: (817) 488-6333
Fax: (817) 809-4355
Type: Mailing
11500 State Highway 121 Bldg 400 Ste 420
Frisco, TX 75035
Phone: (817) 488-6333
Type: Location
1434 W US Highway 287 Byp Ste 100
Waxahachie, TX 751655007
Phone: (817) 488-6333
Type: Location
2200 Physicians Blvd Ste C
Ennis, TX 751196248
Phone: (817) 488-6333
Type: Location
1631 LANCASTER DR STE 235
GRAPEVINE, TX 760513585
Phone: (817) 488-6333
Fax: (817) 809-4355
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: 2018-10-11
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2025-06-30 (344 days ago).
Enrollment records
2
Earliest due date
2025-06-30
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 |
|---|---|---|---|---|
| O20131015000392 | O | Clinic/Group Practice | TX | 2025-06-30 |
| O20181011002823 | O | Physician - Physical And Rehabilitation | TX | 2026-08-31 |
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 76092)
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