JUSTIN ALAN TIDWELL (DPM) – Foot & Ankle Surgery Podiatrist, NPI 1710908892
Foot & Ankle Surgery Podiatrist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
213 PODIATRY in OR
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Provider Addresses for JUSTIN ALAN TIDWELL (DPM)
5815, Northeast 23rd Avenue, Concordia, Portland, Multnomah County, Oregon, 97211, United States
PORTLAND, OR 972115447
Phone: (503) 936-7454
Type: Mailing
501, North Graham Street, Albina, Eliot, Portland, Metro, Multnomah County, Oregon, 97227, United States
SUITE 415
PORTLAND, OR 972271654
Phone: (503) 413-2005
Fax: (503) 413-3699
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 10 Open Payments records for all available years, with a total value of $1,103.
Total Amount is formed as General ($1,103) + Research ($0) + Ownership ($0) = $1,103.
Last reported payment date: 2024-09-05 • Largest payer in this snapshot: TREACE MEDICAL CONCEPTS, INC. ($937).
Total Amount
$1,103
General + Research + Ownership
Payments
10
Total payment records
General Amount
$1,103
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-09-05
Latest reported date
Top Companies
Largest payers in this snapshot
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: 2007-09-11
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 |
|---|---|---|---|---|
| I20070206000698 | I | Podiatry | OR | TBD |
| I20070911000071 | I | Podiatry | WA | 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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 186 | 104 | $0 |
| 99203 | New patient office or other outpatient visit, 30-44 minutes | 151 | 151 | $0 |
| 11042 | Removal of skin and tissue, 20.0 sq cm or less | 131 | 13 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 114 | 59 | $0 |
| 11055 | Removal of noncancer thickened skin growth, 1 growth | 31 | 22 | $0 |
Insurance plans in this area (ZIP 97211)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| PODIATRY | OR | 73630 | X-ray of foot, minimum of 3 views | 58 | 40 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Pulmonary Disease, Internal Medicine | OR | |
| Vascular Surgery, General Surgery | OR | |
| Physician Assistant | OR | |
| Internal Medicine | OR | |
| Critical Care (Intensivists) | OR | |
| - | OR | |
| Internal Medicine | OR | |
| Internal Medicine | OR | |
| Nurse Practitioner | OR | |
| - | OR |
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