BRENT BLUE (MD) – Family Medicine Physician, NPI 1063467538
Family Medicine Physician
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Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
328 FAMILY PRACTICE in WY
Provider Addresses for BRENT BLUE (MD)
PO BOX 15240
JACKSON, WY 830025240
Phone: (307) 733-8002
Type: Mailing
PO BOX 25
WILSON, WY 830140025
Phone: (307) 733-7835
Fax: (307) 201-4999
Type: Mailing
PO BOX 428
JACKSON, WY 830010428
Phone: (307) 733-8002
Fax: (307) 733-0032
Type: Mailing
555 E BROADWAY AVE STE 207
JACKSON, WY 830018640
Phone: (307) 733-8002
Fax: (307) 739-4811
Type: Location
945 W Broadway Ave Apt 202
Jackson, WY 830018217
Phone: (307) 733-7835
Fax: (307) 201-4999
Type: Location
190 MUSTANG DRIVE
DRIGGS, ID 834220000
Phone: (307) 733-7835
Fax: (307) 201-4999
Type: Location
West Broadway Street, Altus, Jackson County, Oklahoma, 73521, United States
JACKSON, WY 830015240
Phone: (307) 733-8002
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: 2010-09-20
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 |
|---|---|---|---|---|
| I20100920000271 | I | Family Practice | WY | 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 |
|---|---|---|---|---|
| 99215 | Established patient office or other outpatient visit, 40-54 minutes | 22 | 18 | $0 |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 13 | 13 | $0 |
Insurance plans in this area (ZIP 83002)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| FAMILY MEDICINE | WY | 81002 | Urinalysis, manual test | 51 | 36 |
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