CONNIE TETEBERG (PA) – Physician Assistant, NPI 1801858923
Physician Assistant
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Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
1,971 PHYSICIAN ASSISTANT in UT
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Provider Addresses for CONNIE TETEBERG (PA)
370, South Temple, The Avenues, Salt Lake City, Salt Lake County, Utah, 84111, United States
STE 260
SALT LAKE CITY, UT 841111206
Phone:
Type: Mailing
Jordan Valley Medical Center - West Valley Campus, 3460, Pioneer Parkway, West Valley City, Salt Lake County, Utah, 84120, United States
WEST VALLEY CITY, UT 841202049
Phone: (801) 964-3100
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $17.
Total Amount is formed as General ($17) + Research ($0) + Ownership ($0) = $17.
Last reported payment date: 2023-01-10 • Largest payer in this snapshot: PFIZER INC. ($17).
Total Amount
$17
General + Research + Ownership
Payments
1
Total payment records
General Amount
$17
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-01-10
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| PFIZER INC. | $17 |
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: 2006-02-02
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 |
|---|---|---|---|---|
| I20060202000408 | I | Physician Assistant | UT | 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 |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 96 | 92 | $0 |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 34 | 34 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 19 | 19 | $0 |
Insurance plans in this area (ZIP 84111)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Family Practice | UT | |
| Internal Medicine | UT | |
| P O D I A T R Y | UT | |
| Physician Assistant | UT | |
| Family Practice | UT | |
| Family Practice | MT | |
| Family Practice | UT | |
| Family Practice | UT | |
| Physician Assistant | UT | |
| Physician Assistant | UT |
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