TUCKER JEPPSON (DO) – Diagnostic Radiology Physician, NPI 1104455922
Diagnostic Radiology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
2,121 DIAGNOSTIC RADIOLOGY in IL
Provider Addresses for TUCKER JEPPSON (DO)
6378 HEPTON LN
LEWISTON, ID 835017846
Phone: (208) 816-8533
Type: Mailing
20201 CRAWFORD AVE
OLYMPIA FIELDS, IL 604611010
Phone: (708) 747-4000
Type: Location
PO BOX 9583
MOSCOW, ID 838430177
Phone: (208) 882-8369
Fax: (208) 882-1887
Type: Mailing
220 W 3RD ST
MOSCOW, ID 838432203
Phone: (208) 882-8369
Type: Location
1200 W Fairview St
Colfax, WA 991119552
Phone: (208) 882-8369
Type: Location
301 Cedar St
Orofino, ID 835449029
Phone: (208) 882-8369
Type: Location
701 Lewiston St
Cottonwood, ID 835229750
Phone: (208) 962-3251
Type: Location
20201 Crawford Ave
Olympia Fields, IL 604611010
Phone: (708) 747-4000
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: 2025-08-05
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
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 |
|---|---|---|---|---|
| I20250804001238 | I | Diagnostic Radiology | WA | TBD |
| I20250805001658 | I | Diagnostic Radiology | ID | 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 83501)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Family Practice | ID | |
| Internal Medicine | WA | |
| Family Practice | ID | |
| Diagnostic Radiology | ID | |
| Family Practice | ID | |
| Diagnostic Radiology | ID | |
| Family Practice | MN | |
| - | ID | |
| Family Practice | ID | |
| General Surgery | CO |
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