Teton Radiology Caldwell – Diagnostic Radiology Physician, NPI 1336920420
Diagnostic Radiology Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Teton Radiology Caldwell
PO BOX 30015
DEPT 598
SALT LAKE CITY, UT 841300015
Phone: (800) 475-6236
Fax: (706) 596-6712
Type: Mailing
4519 ENTERPRISE WAY
CALDWELL, ID 836058055
Phone: (208) 454-0742
Fax: (208) 455-7538
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: 2026-01-30
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 6 Medicare enrollment records; no due dates published yet.
Enrollment records
6
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 |
|---|---|---|---|---|
| O20231227002126 | O | Clinic/Group Practice | UT | TBD |
| O20240116000144 | O | Clinic/Group Practice | WY | TBD |
| O20240131000846 | O | Clinic/Group Practice | MT | TBD |
| O20240320000965 | O | Clinic/Group Practice | ID | TBD |
| O20250609000856 | O | Clinic/Group Practice | TX | TBD |
| O20260130003147 | O | Clinic/Group Practice | NV | 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 84130)
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