KEITH PETTIBON (MD) – Diagnostic Radiology Physician, NPI 1467744573
Diagnostic Radiology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
3,303 DIAGNOSTIC RADIOLOGY in TX
Provider Addresses for KEITH PETTIBON (MD)
816 W CANNON ST
FORT WORTH, TX 761043146
Phone: (817) 321-0404
Type: Mailing
815 PENNSYLVANIA AVE
FORT WORTH, TX 76104
Phone: (817) 321-0404
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 102 Open Payments records for all available years, with a total value of $2,809.
Total Amount is formed as General ($2,809) + Research ($0) + Ownership ($0) = $2,809.
Last reported payment date: 2024-12-18 • Largest payer in this snapshot: Boston Scientific Corporation ($1,154).
Total Amount
$2,809
General + Research + Ownership
Payments
102
Total payment records
General Amount
$2,809
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-18
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Boston Scientific Corporation | $1,154 |
| Inari Medical, Inc. | $528 |
| Surmodics, Inc. | $212 |
| Terumo Medical Corporation | $200 |
| Balt USA, LLC | $155 |
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: 2025-08-22
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 3 Medicare enrollment records; no due dates published yet.
Enrollment records
3
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 |
|---|---|---|---|---|
| I20170328002046 | I | Diagnostic Radiology | TX | TBD |
| I20250822003995 | I | Diagnostic Radiology | MS | TBD |
| I20250822004117 | I | Diagnostic Radiology | LA | 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 |
|---|---|---|---|---|
| 71045 | X-ray of chest, 1 view | 835 | 770 | $0 |
| 70450 | Ct scan head or brain without contrast | 360 | 353 | $0 |
| 74177 | Ct scan of abdomen and pelvis with contrast | 210 | 209 | $0 |
| 75774 | Review by radiologist of additional artery image | 176 | 34 | $0 |
| 74176 | Ct scan of abdomen and pelvis without contrast | 173 | 172 | $0 |
Insurance plans in this area (ZIP 76104)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Diagnostic Radiology | TX | |
| Diagnostic Radiology | TX | |
| Diagnostic Radiology | TX | |
| Diagnostic Radiology | NJ | |
| Diagnostic Radiology | TX | |
| Diagnostic Radiology | TX | |
| Diagnostic Radiology | TX | |
| Diagnostic Radiology | TX | |
| Diagnostic Radiology | TX | |
| Diagnostic Radiology | TX |
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