72nd Street Clinic – Federally Qualified Health Center (FQHC), NPI 1073611364
Federally Qualified Health Center (FQHC)
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for 72nd Street Clinic
2621 S 3270 W
WEST VALLEY CITY, UT 841191119
Phone: (385) 261-2737
Fax: (801) 746-0420
Type: Mailing
220, 7200 South, Midvale, Salt Lake County, Utah, 84047, United States
SUITE A
MIDVALE, UT 840471043
Phone: (801) 566-5494
Fax: (801) 561-9647
Type: Mailing
1455 W 2200 S STE 300
WEST VALLEY CITY, UT 841197219
Phone: (801) 412-6920
Fax: (877) 497-4661
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: 2010-05-15
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2023-07-31 (1043 days ago).
Enrollment records
2
Earliest due date
2023-07-31
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 |
|---|---|---|---|---|
| O20040203000767 | O | Clinic/Group Practice | UT | 2024-08-31 |
| O20100515000133 | O | Federally Qualified Health Center (Fqhc) | UT | 2023-07-31 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
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 84119)
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