DERRICK CHRISTOPHER PENTICUFF – Physical Therapist, NPI 1770107179

DERRICK CHRISTOPHER PENTICUFF is a healthcare provider. based in Pueblo, Colorado. specializing in PHYSICAL THERAPIST IN PRIVATE PRACTICE. The NPI Number for DERRICK CHRISTOPHER PENTICUFF is 1770107179

Main info

Male
6 Years Of Experience
Accepts Medicare Assignment
Name
DERRICK CHRISTOPHER PENTICUFF
NPI
1770107179
Phone
(417) 709-5228
Address
4115 CLUB MANOR DR.
Enumeration Date
1 June 2020
Last Update Date
12 April 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7195689790
Graduation Year
2020 (6 years ago)
PAC ID
5496133514
Group Practice PAC ID
5991920001
Professional Enrollment ID
I20220602000084
Address ID
CO810082014PU4115XDRXX400
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience27
Completeness75
Years active:6State licenses:0Digital endpointsOther names

2,988 PHYSICAL THERAPIST IN PRIVATE PRACTICE in CO

Provider Addresses for DERRICK CHRISTOPHER PENTICUFF

  • 4115 CLUB MANOR DR.

    PUEBLO, CO 81008

    Phone: (417) 709-5228

    Type: Mailing

  • 4115 CLUB MANOR DR

    PUEBLO, CO 81008

    Phone: (968) 568-9790

    Type: Location

  • 3117 W 18TH ST

    PUEBLO, CO 810033866

    Phone: (417) 709-5228

    Type: Mailing

  • 4117 N ELIZABETH ST

    PUEBLO, CO 810082009

    Phone: (719) 545-0788

    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: 2022-06-02

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

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20220602000084IPhysical Therapist In Private PracticeCOTBD

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.

Verify on CMS Revalidation Lookup Tool

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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
97112Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes60362$0
97530Therapy procedure using functional activities57957$0
G0283Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care5817$0
97535Training for self-care or home management, each 15 minutes3930$0
97162Evaluation for physical therapy, typically 30 minutes3030$0
View full utilization report →

Insurance plans in this area (ZIP 81008)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 5991920001View full group profile
NameSpecialtyState
Physical Therapist In Private PracticeCO
Physical Therapist In Private PracticeCO
Physical Therapist In Private PracticeCO
Physical Therapist In Private PracticeWA

Reviews

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Frequently asked questions

Is DERRICK CHRISTOPHER PENTICUFF listed with a National Provider Identifier?
Yes — DERRICK CHRISTOPHER PENTICUFF has NPI 1770107179 on file in the registry.
Would DERRICK CHRISTOPHER PENTICUFF appear as active to a payer?
You can treat DERRICK CHRISTOPHER PENTICUFF as active for directory purposes; confirm clinical privileges separately.
What kind of doctor is DERRICK CHRISTOPHER PENTICUFF?
DERRICK CHRISTOPHER PENTICUFF is associated with Physical Therapist in the directory — Clinical services aligned with this taxonomy classification.
Where in Colorado is DERRICK CHRISTOPHER PENTICUFF registered?
Use Pueblo, Colorado as the headline location for DERRICK CHRISTOPHER PENTICUFF here.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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