MR. RUSSELL HENRY PETERSON (M.S.) – Mental Health Counselor, NPI 1093879637
Mental Health Counselor
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
441 MENTAL HEALTH COUNSELOR in ID
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Provider Addresses for MR. RUSSELL HENRY PETERSON (M.S.)
2375, East Sunnyside Road, Idaho Falls, Bonneville County, Idaho, 83404, United States
SUITE C
IDAHO FALLS, ID 834048280
Phone: (208) 529-5777
Fax: (208) 529-5778
Type: Location
North 4th West, Rigby, Jefferson County, Idaho, 83442, United States
RIGBY, ID 834425892
Phone: (208) 359-4775
Fax: (208) 356-5461
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: 2024-02-21
PECOS data refreshed: 2026-06-15
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 |
|---|---|---|---|---|
| I20240221001874 | I | Mental Health Counselor | 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 83404)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Clinical Psychologist | UT | |
| Nurse Practitioner | UT | |
| Clinical Social Worker | UT |
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