Starlight Provider Group, P.C. – Adult Medicine Physician, NPI 1487301917
Adult Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Starlight Provider Group, P.C.
200 S Executive Dr Ste 101
Brookfield, WI 530054216
Phone: (305) 998-0713
Type: Location
450 Alaskan Way S Ste 200
Seattle, WA 981042785
Phone: (305) 998-0713
Type: Location
100 Chesterfield Business Pkwy Ste 200
Chesterfield, MO 630051271
Phone: (305) 998-0713
Type: Location
8215 SW Tualatin Sherwood Rd Ste 200
Tualatin, OR 970628620
Phone: (305) 998-0713
Type: Location
20 F St NW Fl 7
Washington, DC 200016700
Phone: (305) 998-0713
Type: Location
400 E Pratt St Fl 8
Baltimore, MD 212023180
Phone: (305) 998-0713
Type: Location
445 Minnesota St Ste 1500
Saint Paul, MN 551012269
Phone: (305) 998-0713
Type: Location
5960 Fairview Rd Ste 300&400
Charlotte, NC 282103102
Phone: (305) 998-0713
Type: Location
300 Baker Ave Ste 300
Concord, MA 017422124
Phone: (305) 998-0713
Type: Location
1615 Poydras St Ste 900
New Orleans, LA 701121282
Phone: (305) 998-0713
Type: Location
9465 Counselors Row Ste 200
Indianapolis, IN 462403817
Phone: (305) 998-0713
Type: Location
295 E Renfro St Ste 300
Burleson, TX 760283954
Phone: (305) 998-0713
Type: Location
2858 UNIVERSITY AVE # 266
MADISON, WI 537053644
Phone:
Type: Mailing
2134 W LAWN AVE
MADISON, WI 537111950
Phone: (415) 390-6008
Type: Location
2332 GALIANO ST FL 2
CORAL GABLES, FL 331345402
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.
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: 2025-10-03
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 16 Medicare enrollment records; no due dates published yet.
Enrollment records
16
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 |
|---|---|---|---|---|
| O20230908003087 | O | Clinic/Group Practice | OH | TBD |
| O20230908003483 | O | Clinic/Group Practice | IL | TBD |
| O20230919000237 | O | Clinic/Group Practice | MO | TBD |
| O20230919000477 | O | Clinic/Group Practice | MI | TBD |
| O20230919003926 | O | Clinic/Group Practice | MN | TBD |
| O20231012002906 | O | Clinic/Group Practice | WI | TBD |
| O20250423002799 | O | Clinic/Group Practice | NC | TBD |
| O20250505001374 | O | Clinic/Group Practice | OR | TBD |
| O20250506002768 | O | Clinic/Group Practice | WA | TBD |
| O20250513001890 | O | Clinic/Group Practice | FL | TBD |
| O20250603000654 | O | Clinic/Group Practice | MD | TBD |
| O20250603001371 | O | Clinic/Group Practice | DC | TBD |
| O20250610002832 | O | Clinic/Group Practice | MA | TBD |
| O20250617004055 | O | Clinic/Group Practice | LA | TBD |
| O20250617004246 | O | Clinic/Group Practice | TX | TBD |
| O20251003001242 | O | Clinic/Group Practice | IN | 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 53005)
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