Unknown Individual – Pediatric Critical Care Medicine Physician, NPI 1023019056
Pediatric Critical Care Medicine Physician
Main info
Contacts
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Unknown Individual
Naval Medical Center Portsmouth, PICU
620 John Paul Jones Circle
Portsmouth, VA 23708
Phone: (757) 953-4528
Fax: (757) 953-7774
Type: Location
1906 Belleview Ave SE
Roanoke, VA 240141838
Phone: (540) 981-7000
Fax: (540) 985-4780
Type: Location
1638 Owen Dr
Fayetteville, NC 283043424
Phone: (910) 615-5590
Type: Location
2131 S 17TH ST
WILMINGTON, NC 284017407
Phone: (910) 667-7360
Type: Location
213 S JEFFERSON ST STE 1006
ROANOKE, VA 240111713
Phone: (540) 224-5352
Type: Mailing
1115, Fairway Drive, Ashley Woods, Chesapeake, Virginia, 23320, United States
CHESAPEAKE, VA 233209440
Phone: (757) 312-8210
Type: Mailing
NAVAL MEDICAL CENTER PORTSMOUTH, PICU
620 JOHN PAUL JONES CIRCLE
PORTSMOUTH, VA 23708
Phone: (757) 953-4528
Fax: (757) 953-7774
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 3 Open Payments records for all available years, with a total value of $13,849.
Total Amount is formed as General ($149) + Research ($13,700) + Ownership ($0) = $13,849.
Last reported payment date: 2023-08-24 • Largest payer in this snapshot: PFIZER INC. ($13,700).
Total Amount
$13,849
General + Research + Ownership
Payments
3
Total payment records
General Amount
$149
General payments
Research Amount
$13,700
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-08-24
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| PFIZER INC. | $13,700 |
| Davol Inc. | $149 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
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 |
|---|---|---|---|---|
| I20150318002404 | I | Pediatric Medicine | NC | TBD |
| I20230410002572 | I | Pediatric Medicine | VA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
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 23708)
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