MR. DAVID ALDEN BOEDEKER (PA-C) – Medical Physician Assistant, NPI 1508311085
Medical Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
324 PHYSICIAN ASSISTANT in WY
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Provider Addresses for MR. DAVID ALDEN BOEDEKER (PA-C)
Campbell County Health, 501, South Burma Avenue, Gillette, Campbell County, Wyoming, 82716, United States
GILLETTE, WY 827163426
Phone: (307) 688-1000
Type: Mailing
508, Stocktrail Avenue, Gillette, Campbell County, Wyoming, 82718, United States
SUITE A
GILLETTE, WY 827163582
Phone: (307) 686-1413
Type: Location
2815 S. PENNSYLVANIA AVE
SUITE 204
LANSING, MI 489103496
Phone: (517) 267-0200
Fax: (517) 267-1877
Type: Mailing
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: 2025-04-21
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 3 Medicare enrollment records; no due dates published yet.
Enrollment records
3
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 |
|---|---|---|---|---|
| I20160929000599 | I | Physician Assistant | WY | TBD |
| I20190626001130 | I | Physician Assistant | MI | TBD |
| I20250421002627 | I | Physician Assistant | SD | 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 82716)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Orthopedic Surgery | SD | |
| - | SD | |
| Orthopedic Surgery | SD | |
| N E U R O L O G Y | SD | |
| Physician Assistant | SD | |
| Orthopedic Surgery | SD | |
| Physician Assistant | SD | |
| Nurse Practitioner | SD | |
| Orthopedic Surgery | SD | |
| Orthopedic Surgery, Hand Surgery, Orthopedic Surgery | SD |
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