DR. SAMUEL JAMES OTTO (M.D.) – Urology Physician, NPI 1154565273
Urology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for DR. SAMUEL JAMES OTTO (M.D.)
400 East, Tooele, Tooele County, Utah, 84704, United States
STE A104
TOOELE, UT 840743413
Phone: (435) 882-0071
Fax: (435) 882-0073
Type: Mailing
2424, South 90th Street, Eckel Woods, West Allis, Milwaukee County, Wisconsin, 53227, United States
SUITE 408
MILWAUKEE, WI 532272455
Phone: (414) 385-2716
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: 2018-05-18
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 |
|---|---|---|---|---|
| I20090903000153 | I | Urology | UT | TBD |
| I20180518001463 | I | Urology | TX | 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 84074)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| UROLOGY | WI | 76942 | Ultrasonic guidance imaging supervision and interpretation for insertion of needle | 11 | 11 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| - | UT |
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