One provider matched this enrollment ID.
Enrollment ID O20040109001065 resolves to a single NPI record. Open the full profile for complete detail.
Medicare enrollment
This provider holds 20 Medicare enrollments on file with the Provider Enrollment, Chain and Ownership System (PECOS). Each enrollment carries a public Medicare Enrollment ID (ENRLMT_ID) used by billers and intermediaries.
Part B Supplier
- O20031106000511Clinic/Group PracticeMN
- O20040109001065Clinic/Group PracticeWI
- O20090504000672Clinic/Group PracticeFL
- O20090617000203Clinic/Group PracticeCA
- O20130711000198Clinic/Group PracticeGA
- O20130801000269Clinic/Group PracticeAZ
- O20131212000908Clinic/Group PracticeTX
- O20131217000947Clinic/Group PracticeSD
- O20141027000091Clinic/Group PracticeCO
- O20170419002642Clinic/Group PracticeWA
- O20191016001915Clinic/Group PracticeRI
- O20201006000559Clinic/Group PracticeMO
- O20210602001609Clinic/Group PracticeNY
- O20220624001452Clinic/Group PracticeME
- O20221014001863Clinic/Group PracticeVT
- O20230608002132Clinic/Group PracticeMA
- O20230609002692Clinic/Group PracticeKY
- O20230822002763Clinic/Group PracticePA
- O20240620000067Clinic/Group PracticeIA
- O20260206000472Clinic/Group PracticeNC
Source: CMS PECOS public enrollment file.
Secondary identifiers
Additional identifiers this provider has registered with NPPES. Used by medical billers, credentialers, and insurance verifiers to cross-reference claims and enrollments.
Other
- 03083COMN· Issued by BC/BS
- CC7547MN· Issued by RR MEDICARE
- CG5296WI· Issued by RR MEDICARE
Source: NPPES public registry.
ReferenceAbout Medicare Enrollment IDs
A Medicare Enrollment ID (ENRLMT_ID) is a 15-character public identifier assigned by the CMS Provider Enrollment, Chain and Ownership System (PECOS) when a provider, supplier, or organisation enrols in Medicare. Each row reflects one enrolment record: a single NPI can hold multiple enrolments across provider types, states, or supplier categories. Data here is mirrored from the quarterly public PECOS enrolment file published on data.cms.gov.