Premier Pediatrics & OB/GYN – Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician, NPI 1396274296
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Premier Pediatrics & OB/GYN
PO BOX 3662
LONGVIEW, TX 756063662
Phone: (903) 301-9343
Fax: (903) 939-0049
Type: Mailing
703 E Marshall Ave Ste 4002
Longview, TX 756015622
Phone: (903) 315-2700
Fax: (903) 236-2575
Type: Location
109 Zeid Blvd
Henderson, TX 756526070
Phone: (903) 655-4200
Fax: (903) 655-4353
Type: Location
PO BOX 6277
TYLER, TX 757116277
Phone: (903) 301-9343
Fax: (903) 939-0049
Type: Mailing
East Marshall Avenue, Longview, Gregg County, Texas, 75601, United States
LONGVIEW, TX 756015622
Phone: (903) 315-2700
Fax: (903) 236-2575
Type: Location
1212 CLINIC DR
TYLER, TX 757012117
Phone: (903) 301-9343
Fax: (903) 939-0049
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: 2017-07-07
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2024-04-30 (769 days ago).
Enrollment records
1
Earliest due date
2024-04-30
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 |
|---|---|---|---|---|
| O20170707000961 | O | Clinic/Group Practice | TX | 2024-04-30 |
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 75606)
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