DEREK GARN RODEBACK (D.O.) – Sports Medicine (Physical Medicine & Rehabilitation) Physician, NPI 1053751032
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
83 OSTEOPATHIC MANIPULATIVE MEDICINE in CO
Provider Addresses for DEREK GARN RODEBACK (D.O.)
350 BROADWAY ST STE 202
BOULDER, CO 803053338
Phone: (720) 463-0567
Fax: (303) 494-5371
Type: Mailing
1818 MUELLER PARK RD
BOUNTIFUL, UT 840101105
Phone: (453) 414-9858
Type: Mailing
PO BOX 27128
SALT LAKE CITY, UT 841270128
Phone: (435) 688-4700
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: 2021-07-06
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
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 |
|---|---|---|---|---|
| I20210706000973 | I | Physical Medicine And Rehabilitation | UT | 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 80305)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | OR | |
| Diagnostic Radiology | UT | |
| Family Practice | UT | |
| H O S P I T A L I S T | UT | |
| O B S T E T R I C S/ G Y N E C O L O G Y | UT | |
| - | UT | |
| - | UT | |
| - | UT | |
| Family Practice | UT | |
| - | UT |
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