INTERVENTIONAL SPINE & PAIN MANAGEMENT – Pain Medicine (Anesthesiology) Physician, NPI 1609204338
Pain Medicine (Anesthesiology) Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for INTERVENTIONAL SPINE & PAIN MANAGEMENT
13953 S Bangerter Pkwy
Draper, UT 840205429
Phone: (801) 262-7246
Type: Location
346 E State Rd
Pleasant Grove, UT 840623617
Phone: (801) 262-7246
Type: Location
1276 Wall Ave Ste 2
Ogden, UT 844045673
Phone: (801) 262-7246
Type: Location
900 Round Valley Dr Ste 120
Park City, UT 840607552
Phone: (801) 262-7246
Type: Location
2380 N 400 E Ste A
North Logan, UT 843411756
Phone: (435) 713-9681
Fax: (435) 753-1201
Type: Location
274 N MAIN ST
LOGAN, UT 843213915
Phone: (435) 753-1600
Fax: (435) 753-9521
Type: Mailing
5801 S FASHION BLVD STE 180
MURRAY, UT 841078135
Phone: (801) 262-7246
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: 2014-02-19
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
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 |
|---|---|---|---|---|
| O20140219000458 | 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 84020)
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Reviews
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