DR. GEOFFRY JR. DE GENNARO (M.D.) – Diagnostic Radiology Physician, NPI 1336554740

DR. GEOFFRY JR. DE GENNARO (M.D.) is a healthcare provider. based in Boise, Idaho. specializing in DIAGNOSTIC RADIOLOGY. They hold the professional credentials M.D.. They hold a License No. 4301105483 (MI). The NPI Number for DR. GEOFFRY JR. DE GENNARO (M.D.) is 1336554740

Main info

Male
12 Years Of Experience
Accepts Medicare Assignment
Name
DR. GEOFFRY JR. DE GENNARO (M.D.)
NPI
1336554740
Phone
(208) 381-2094
Address
190 E BANNOCK ST
Enumeration Date
24 June 2014
Last Update Date
23 July 2020

Doctor Profile

Medical School Name
MEDICAL COLLEGE OF WISCONSIN
Secondary Phone
4102980454
Graduation Year
2014 (12 years ago)
PAC ID
5496971715
Group Practice PAC ID
6103259304
Professional Enrollment ID
I20200609002283
Address ID
ID837127570BO2899XRDXX500
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience55
Completeness75
Years active:11State licenses:2Digital endpointsOther names

195 DIAGNOSTIC RADIOLOGY in ID

Provider Addresses for DR. GEOFFRY JR. DE GENNARO (M.D.)

  • 190 E BANNOCK ST

    BOISE, ID 837126241

    Phone: (208) 381-2094

    Mailing address matches the actual address.

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: 2020-06-09

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
I20200609002283IDiagnostic RadiologyIDTBD

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
70450Ct scan head or brain without contrast308295$0
72100X-ray of lower and sacral spine, 2-3 views257249$0
71045X-ray of chest, 1 view228228$0
70551Mri scan of brain without contrast170170$0
70496Ct scan of blood vessels of head with contrast155155$0
View full utilization report →

Insurance plans in this area (ZIP 83712)

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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: 6103259304View full group profile
NameSpecialtyState
Diagnostic RadiologyMD
Diagnostic RadiologyMD
Diagnostic RadiologyMD
Diagnostic RadiologyMD
Diagnostic RadiologyPA
Diagnostic RadiologyTX
Diagnostic RadiologyMD
Diagnostic RadiologyMD
Diagnostic RadiologyMD
Diagnostic RadiologyNY

Reviews

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Frequently asked questions

Is there an official ID for DR. GEOFFRY JR. DE GENNARO (M.D.) in U.S. healthcare records?
The official identifier for DR. GEOFFRY JR. DE GENNARO (M.D.) is NPI 1336554740.
Is DR. GEOFFRY JR. DE GENNARO (M.D.) still an active registrant?
DR. GEOFFRY JR. DE GENNARO (M.D.) carries an active NPI according to the public dataset.
What expertise is attributed to DR. GEOFFRY JR. DE GENNARO (M.D.)?
DR. GEOFFRY JR. DE GENNARO (M.D.)'s specialty line reads Diagnostic Radiology Physician. Clinical services aligned with this taxonomy classification.
Is DR. GEOFFRY JR. DE GENNARO (M.D.) associated with Boise?
Public fields place DR. GEOFFRY JR. DE GENNARO (M.D.) around Boise, Idaho. Always confirm the exact site before visiting.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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