Professional Wound Specialists – Surgery Physician, NPI 1699975144
Surgery Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Professional Wound Specialists
9980 S 300 W Ste 200
Sandy, UT 840703654
Phone: (888) 434-8880
Fax: (855) 434-8880
Type: Location
120, South Jones Boulevard, Charleston Heights, Las Vegas, Clark County, Nevada, 89107, United States
LAS VEGAS, NV 891032209
Phone: (702) 434-8880
Fax: (702) 862-8880
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: 2025-05-09
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
6
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 |
|---|---|---|---|---|
| O20070823000045 | O | Clinic/Group Practice | NV | TBD |
| O20171129001743 | O | Clinic/Group Practice | UT | 2024-07-31 |
| O20211130000256 | O | Clinic/Group Practice | NM | TBD |
| O20220223000023 | O | Clinic/Group Practice | CA | TBD |
| O20220408001817 | O | Clinic/Group Practice | ID | TBD |
| O20250509000985 | O | Clinic/Group Practice | CO | TBD |
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 84070)
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