MARK PRUITT (D.O.) – Emergency Medicine Physician, NPI 1124432943
Emergency Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
270 EMERGENCY MEDICINE in ID
Provider Addresses for MARK PRUITT (D.O.)
6640 KANIKSU ST
BONNERS FERRY, ID 838057532
Phone: (208) 267-3141
Type: Mailing
714 W Pine St
Newport, WA 991569046
Phone: (509) 447-2441
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: 2018-07-05
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 |
|---|---|---|---|---|
| I20180202001754 | I | Emergency Medicine | WA | TBD |
| I20180705003041 | I | Emergency Medicine | 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 83805)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Diagnostic Radiology | ID | |
| Emergency Medicine | ID | |
| Clinical Social Worker | ID | |
| Internal Medicine | ID | |
| - | ID | |
| Family Practice | ID | |
| Nurse Practitioner | ID | |
| Diagnostic Radiology | ID | |
| Interventional Radiology, Nuclear Medicine, Diagnostic Radiology | CO | |
| Diagnostic Radiology | ID |
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