Box Elder Community Health Center – Family Medicine Physician, NPI 1629309786
Family Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Box Elder Community Health Center
517 W 100 N STE 210
PROVIDENCE, UT 843329826
Phone: (435) 755-6061
Fax: (435) 994-8362
Type: Mailing
325 WEST LOGAN HIGHWAY
GARDEN CITY, UT 840288001
Phone: (435) 946-3660
Fax: (435) 946-8215
Type: Location
1515 N 400 E Ste 104
North Logan, UT 843417595
Phone: (435) 755-6061
Fax: (435) 994-8362
Type: Location
2620 Commercial Way Ste 140
Rock Springs, WY 829014750
Phone: (435) 755-6061
Fax: (435) 994-8362
Type: Location
5 W 200 N
Brigham City, UT 843022109
Phone: (435) 755-6061
Fax: (435) 994-8362
Type: Location
152 S 4th St
Montpelier, ID 832541538
Phone: (435) 755-6061
Fax: (435) 994-8362
Type: Location
120 S Main St
Randolph, UT 840647701
Phone: (435) 755-6061
Fax: (435) 994-8362
Type: Location
75 Yellow Creek Rd Ste 102
Evanston, WY 829305205
Phone: (435) 755-6061
Fax: (435) 994-8362
Type: Location
517 W 100 N Ste 110
Providence, UT 843329826
Phone: (435) 755-6061
Fax: (435) 994-8362
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
Loading prescription activity...
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.
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 |
|---|---|---|---|---|
| O20040110000158 | 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 84332)
Loading plans...
Reviews
All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.
No reviews yet. Be the first to share your experience — your opinion helps families compare providers.