JACKSONVILLE LUNG CLINIC LLC – Critical Care Medicine (Internal Medicine) Physician, NPI 1861991937
Critical Care Medicine (Internal Medicine) Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for JACKSONVILLE LUNG CLINIC LLC
7500 RIALTO BLVD
AUSTIN, TX 787358531
Phone: (512) 730-3060
Type: Mailing
1350 13TH AVE S
JACKSONVILLE BEACH, FL 322503203
Phone: (904) 627-2900
Fax: (904) 253-3098
Type: Location
7500 Rialto Blvd Ste 1-140
Austin, TX 78735
Phone: (512) 730-3060
Fax: (888) 730-1925
Type: Location
Atlantic Blvd, Jacksonville, Duval County, Florida, 32246, United States
JACKSONVILLE, FL 322073633
Phone: (904) 513-3240
Fax: (904) 253-3098
Type: Mailing
Rialto Boulevard, Austin, Travis County, Texas, 78735, United States
AUSTIN, TX 78735
Phone: (512) 730-3060
Fax: (888) 730-1925
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: 2018-07-05
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2024-07-31 (678 days ago).
Enrollment records
1
Earliest due date
2024-07-31
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 |
|---|---|---|---|---|
| O20180705002822 | O | Clinic/Group Practice | FL | 2024-07-31 |
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 78735)
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