PHYLLIS A PENNINGTON (DO) – Family Medicine Physician, NPI 1720377740
Family Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
2,661 FAMILY PRACTICE in CO
Provider Addresses for PHYLLIS A PENNINGTON (DO)
825 W 6TH ST
LEADVILLE, CO 804612205
Phone: (719) 486-1264
Fax: (719) 486-1286
Type: Location
825 W 6th St
Leadville, CO 804612205
Phone: (719) 486-1264
Fax: (719) 486-1286
Type: Location
1338 PHAY AVE
CANON CITY, CO 812122311
Phone: (719) 285-2700
Fax: (719) 285-2975
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: 2017-01-25
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 |
|---|---|---|---|---|
| I20170125002441 | I | Family Practice | CO | 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 80461)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | CO | |
| Radiation Oncology | TX | |
| - | CO | |
| Hospitalist, General Practice, Family Practice | CO | |
| Cardiovascular Disease (Cardiology) | NM | |
| Family Practice | OK | |
| Internal Medicine | CO | |
| - | IL | |
| H E M A T O L O G Y/ O N C O L O G Y | TX | |
| Internal Medicine | PA |
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