CANVI BEHAVIORAL HEALTH PLLC – Psychiatric/Mental Health Nurse Practitioner, NPI 1144984873
Psychiatric/Mental Health Nurse Practitioner
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Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for CANVI BEHAVIORAL HEALTH PLLC
347 W Gordon Ave Ste 1
Layton, UT 840412389
Phone: (801) 896-5341
Fax: (801) 896-5334
Type: Location
333 W Cedar St Ste 3
Pocatello, ID 832015045
Phone: (208) 252-5621
Fax: (208) 648-4167
Type: Location
1120 Stocks Ave Ste 102
Rexburg, ID 834403508
Phone: (208) 745-2580
Fax: (208) 648-4167
Type: Location
476 Heritage Park Blvd Ste 230
Layton, UT 840415636
Phone: (801) 896-5345
Fax: (801) 896-5334
Type: Location
PO BOX 2516
POCATELLO, ID 832062516
Phone: (208) 380-4978
Fax: (208) 648-4063
Type: Mailing
4650 HAWTHORNE RD STE 3B
CHUBBUCK, ID 832022376
Phone: (208) 252-5621
Fax: (208) 648-4167
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: 2022-06-14
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
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 |
|---|---|---|---|---|
| O20220121000627 | O | Clinic/Group Practice | ID | TBD |
| O20220614002943 | O | Clinic/Group Practice | UT | 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 84041)
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