TERI S FORMANEK (M.D.) – Orthopaedic Surgery Physician, NPI 1982644993
Orthopaedic Surgery Physician
Main info
Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
287 ORTHOPEDIC SURGERY in IA
Provider Addresses for TERI S FORMANEK (M.D.)
12499 University Ave
Suite 210
Clive, IA 503258281
Phone: (515) 440-2676
Fax: (515) 245-6422
Type: Location
Madison County Memorial Hospital, 300, West Hutchings Street, Winterset, Madison County, Iowa, 50273, United States
WINTERSET, IA 502732109
Phone: (515) 462-2373
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 4 Open Payments records for all available years, with a total value of $1,083.
Total Amount is formed as General ($1,083) + Research ($0) + Ownership ($0) = $1,083.
Last reported payment date: 2024-12-05 • Largest payer in this snapshot: Arthrex, Inc. ($830).
Total Amount
$1,083
General + Research + Ownership
Payments
4
Total payment records
General Amount
$1,083
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-05
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Arthrex, Inc. | $830 |
| Abbott Laboratories | $136 |
| Wardlow Enterprises | $117 |
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: 2010-06-02
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
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20100602000422 | I | Hand Surgery | IA | 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 50325)
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Provider's Procedures
Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | IA | |
| Nurse Practitioner | IA | |
| Family Practice | IA | |
| Physician Assistant | IA | |
| O T O L A R Y N G O L O G Y | IA | |
| Family Practice, Emergency Medicine | IA | |
| Family Practice | IA | |
| Nurse Practitioner | IA | |
| Nurse Practitioner | WA | |
| Physician Assistant | IA |
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