DERIK K KENWORTHY (DO) – Diagnostic Radiology Physician, NPI 1861726077
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 DERIK K KENWORTHY (DO)
1110 N Sarah DeWitt Dr
Gonzales, TX 786293311
Phone: (816) 800-9020
Type: Location
1460 G St
Springfield, OR 974774112
Phone: (816) 800-9020
Type: Location
3600 MINNESOTA DR STE 800
EDINA, MN 554357915
Phone: (952) 595-1100
Fax: (612) 294-4903
Type: Mailing
1979 W Ray Rd
Chandler, AZ 852244007
Phone: (480) 821-9404
Fax: (480) 857-1490
Type: Location
South Clearview Avenue, Mesa, Maricopa County, Arizona, 85206, United States
MESA, AZ 852093378
Phone: (480) 988-9108
Fax: (480) 813-4460
Type: Mailing
West Ray Road, Thunderbird Plaza, Chandler, Maricopa County, Arizona, 85225, United States
CHANDLER, AZ 852244007
Phone: (480) 821-9404
Fax: (480) 857-1490
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: 2025-11-07
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 6 Medicare enrollment records; no due dates published yet.
Enrollment records
6
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 |
|---|---|---|---|---|
| I20240920003617 | I | Diagnostic Radiology | TX | TBD |
| I20241104001444 | I | Diagnostic Radiology | KS | TBD |
| I20250113001239 | I | Diagnostic Radiology | OR | TBD |
| I20250321003245 | I | Diagnostic Radiology | MT | TBD |
| I20250717000989 | I | Diagnostic Radiology | UT | TBD |
| I20251107000213 | I | Diagnostic Radiology | CO | 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 78629)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Diagnostic Radiology | VA | |
| - | WV | |
| Nurse Practitioner | FL | |
| Diagnostic Radiology | OR | |
| Diagnostic Radiology | OR | |
| Cardiovascular Disease (Cardiology) | AR | |
| Diagnostic Radiology | TX | |
| Diagnostic Radiology | TX | |
| - | MN | |
| Diagnostic Radiology, Internal Medicine | WA |
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