UTAH KIDNEY CLINIC LLC – Nephrology Physician, NPI 1013520154
Nephrology Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for UTAH KIDNEY CLINIC LLC
4345 HARRISON BLVD STE 101
OGDEN, UT 844033103
Phone: (385) 350-8500
Fax: (844) 946-0909
Type: Location
480 N 100 E Ste 110
Logan, UT 843216674
Phone: (435) 932-2038
Fax: (435) 359-2856
Type: Location
3584 W 9000 S Ste 305
West Jordan, UT 840884775
Phone: (385) 350-8500
Fax: (385) 350-8555
Type: Location
1820 E 17TH ST STE 330
IDAHO FALLS, ID 834046400
Phone:
Type: Mailing
990 Medical Dr Ste G4
Brigham City, UT 843023077
Phone: (435) 932-2038
Fax: (435) 359-2856
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: 2020-10-06
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Revalidation due soon
Earliest CMS due date is 2026-08-31 (83 days away).
Enrollment records
1
Earliest due date
2026-08-31
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 |
|---|---|---|---|---|
| O20201006002557 | O | Clinic/Group Practice | UT | 2026-08-31 |
What to do next
- Confirm the due date on the CMS Revalidation Lookup Tool.
- Complete revalidation in PECOS before the published due date.
- If you have multiple enrollment records, revalidate each one on its own schedule.
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 84403)
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