MR. ROBERT TYLER REIDENBAUGH (MD) – Addiction Medicine (Psychiatry & Neurology) Physician, NPI 1487097762
Addiction Medicine (Psychiatry & Neurology) Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
710 PSYCHIATRY in WA
Provider Addresses for MR. ROBERT TYLER REIDENBAUGH (MD)
12101 AMBAUM BLVD SW
BURIEN, WA 98146
Phone: (206) 966-6273
Type: Location
PO BOX 4369
BOISE, ID 837114369
Phone: (208) 810-2310
Type: Mailing
5 W MENDENHALL ST
STE 202
BOZEMAN, MT 59715
Phone: (406) 219-7233
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: 2023-02-23
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 |
|---|---|---|---|---|
| I20180312001090 | I | Psychiatry | WA | TBD |
| I20230223002404 | I | Psychiatry | MT | 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 98146)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| P S Y C H I A T R Y | WA | |
| Nurse Practitioner | MT | |
| P S Y C H I A T R Y | WY | |
| Physician Assistant | MT | |
| Nurse Practitioner | MT | |
| Family Practice, Obstetrics/Gynecology | MT | |
| Clinical Social Worker | MT | |
| Nurse Practitioner | MT | |
| Nurse Practitioner | MT | |
| Nurse Practitioner | MT |
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