BOISE RADIOLOGY GROUP PLLC – Diagnostic Radiology Physician, NPI 1740216175
Diagnostic Radiology Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for BOISE RADIOLOGY GROUP PLLC
PO BOX 17170
RENO, NV 895117170
Phone: (800) 672-7210
Fax: (208) 576-7593
Type: Mailing
St. Luke's Boise Medical Center, 190, East Bannock Street, Downtown, Boise, Ada County, Idaho, 83712, United States
BOISE, ID 837126241
Phone: (208) 433-9466
Fax: (208) 433-1149
Type: Location
PO BOX 1108
CORVALLIS, OR 973391108
Phone: (805) 286-3826
Fax: (208) 576-7593
Type: Mailing
PO BOX 1616
EVANSVILLE, IN 477060018
Phone: (208) 381-2094
Fax: (208) 381-1791
Type: Mailing
620 W HAYS ST
BOISE, ID 837025511
Phone: (208) 381-2094
Fax: (208) 381-1791
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: 2026-01-07
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 11 Medicare enrollment records; no due dates published yet.
Enrollment records
11
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 |
|---|---|---|---|---|
| O20040614000277 | O | Clinic/Group Practice | ID | TBD |
| O20230201001921 | O | Clinic/Group Practice | PA | TBD |
| O20230707000528 | O | Clinic/Group Practice | WA | TBD |
| O20241212000246 | O | Clinic/Group Practice | UT | TBD |
| O20250303003021 | O | Clinic/Group Practice | AZ | TBD |
| O20250623001538 | O | Clinic/Group Practice | CA | TBD |
| O20250718003435 | O | Clinic/Group Practice | KS | TBD |
| O20250912001575 | O | Clinic/Group Practice | IL | TBD |
| O20251029003021 | O | Clinic/Group Practice | CT | TBD |
| O20260107000285 | O | Clinic/Group Practice | NC | TBD |
| O20260107003693 | O | Clinic/Group Practice | TN | 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 89511)
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