CCMMA SC LLC – Critical Care Medicine (Internal Medicine) Physician, NPI 1245715796
Critical Care Medicine (Internal Medicine) Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for CCMMA SC LLC
1015 Priory Pl
Mc Lean, VA 221012134
Phone: (845) 702-2711
Fax: (888) 220-6560
Type: Location
120 Leeuwarden Rd
Darien, CT 068203027
Phone: (845) 702-2711
Fax: (888) 220-6560
Type: Location
224 W 18TH ST APT 8A
NEW YORK, NY 100114558
Phone: (914) 523-2189
Type: Location
5315 E Larkspur Dr
Scottsdale, AZ 852544227
Phone: (845) 702-2711
Fax: (888) 220-6560
Type: Location
425 W 5th St
East Liverpool, OH 439202498
Phone: (330) 385-7200
Fax: (888) 220-6560
Type: Location
350 Boulevard
Passaic, NJ 070552840
Phone: (973) 365-4300
Type: Location
625 Gore Range Dr
Severance, CO 805504869
Phone: (845) 702-2711
Fax: (888) 220-6560
Type: Location
27 Henderson St
Arlington, MA 024745507
Phone: (845) 702-2711
Fax: (888) 220-6560
Type: Location
5605 Poola St
Honolulu, HI 968211564
Phone: (845) 702-2711
Fax: (888) 220-6560
Type: Location
386 Acadian Ct
Biloxi, MS 395312900
Phone: (845) 702-2711
Fax: (888) 220-6560
Type: Location
1481 Hollis Rdg
Clarksville, TN 370431522
Phone: (845) 702-2711
Fax: (888) 220-6560
Type: Location
201 NW R D Mize Rd
Blue Springs, MO 640142513
Phone: (816) 228-5900
Fax: (888) 220-6560
Type: Location
600 S Monroe St
Enid, OK 737017211
Phone: (580) 233-2300
Fax: (888) 220-6560
Type: Location
59-351 Lehiwa Pl
Kamuela, HI 967438581
Phone: (845) 702-2711
Fax: (888) 220-6560
Type: Location
10 Nadia S Way
Farmington, CT 060322860
Phone: (845) 702-2711
Fax: (888) 220-6560
Type: Location
6565 Fannin St
Houston, TX 770302703
Phone: (713) 790-3311
Fax: (888) 220-6560
Type: Location
120 N Delaware St
Sandusky, MI 484711009
Phone: (810) 648-3770
Fax: (888) 220-6560
Type: Location
PO BOX 631797
CINCINNATI, OH 452631797
Phone: (845) 702-2711
Fax: (888) 220-6560
Type: Mailing
129 N WASHINGTON ST
SUMTER, SC 291504949
Phone: (803) 774-9000
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: 2026-02-27
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2023-12-31 (893 days ago).
Enrollment records
21
Earliest due date
2023-12-31
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 |
|---|---|---|---|---|
| O20181213003271 | O | Clinic/Group Practice | SC | 2023-12-31 |
| O20210525003392 | O | Clinic/Group Practice | OH | TBD |
| O20221004002473 | O | Clinic/Group Practice | MS | TBD |
| O20221017003248 | O | Clinic/Group Practice | HI | TBD |
| O20221018000711 | O | Clinic/Group Practice | CT | TBD |
| O20221018001201 | O | Clinic/Group Practice | DC | TBD |
| O20221019002475 | O | Clinic/Group Practice | MA | TBD |
| O20221020001129 | O | Clinic/Group Practice | CO | TBD |
| O20221103000207 | O | Clinic/Group Practice | AZ | TBD |
| O20221114001570 | O | Clinic/Group Practice | TN | TBD |
| O20221205002410 | O | Clinic/Group Practice | VA | TBD |
| O20230929000923 | O | Clinic/Group Practice | OR | TBD |
| O20231010002566 | O | Clinic/Group Practice | IN | TBD |
| O20231120002491 | O | Clinic/Group Practice | NM | TBD |
| O20231130000567 | O | Clinic/Group Practice | AL | TBD |
| O20240103004298 | O | Clinic/Group Practice | IA | TBD |
| O20240416002757 | O | Clinic/Group Practice | GA | TBD |
| O20250902002967 | O | Clinic/Group Practice | NV | TBD |
| O20250905000492 | O | Clinic/Group Practice | WA | TBD |
| O20260113003031 | O | Clinic/Group Practice | KS | TBD |
| O20260227000134 | O | Clinic/Group Practice | WI | 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 22101)
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