CHARLOTTESVILLE RADIOLOGY – Surgery Physician, NPI 1063532869
Surgery Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for CHARLOTTESVILLE RADIOLOGY
PO BOX 2546
VIRGINIA BEACH, VA 234502546
Phone: (757) 340-2864
Fax: (757) 340-4278
Type: Mailing
1490 PANTOPS MOUNTAIN PL STE 100
CHARLOTTESVILLE, VA 229114601
Phone: (434) 244-4580
Fax: (434) 244-4579
Type: Location
500 MARTHA JEFFERSON DR
CHARLOTTESVILLE, VA 229114668
Phone: (434) 654-7000
Type: Location
PO BOX 197
STATE COLLEGE, PA 168040197
Phone:
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.
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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)
Revalidation due soon
Earliest CMS due date is 2026-07-31 (47 days away).
Enrollment records
1
Earliest due date
2026-07-31
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 |
|---|---|---|---|---|
| O20040602001497 | O | Clinic/Group Practice | VA | 2026-07-31 |
What to do next
- Confirm the due date on the CMS Revalidation Lookup Tool.
- Complete revalidation in PECOS before the published due date.
- If you have multiple enrollment records, revalidate each one on its own schedule.
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 23450)
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