EDGEMONT PHARMACY – Community/Retail Pharmacy, NPI 1659301885
Community/Retail Pharmacy
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for EDGEMONT PHARMACY
North Canyon Road, BYU, Provo, Utah County, Utah, 84604, United States
PROVO, UT 846044536
Phone: (801) 226-7994
Fax: (801) 226-2166
Mailing address matches the actual address.
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: 2011-12-06
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2025-07-31 (314 days ago).
Enrollment records
2
Earliest due date
2025-07-31
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 |
|---|---|---|---|---|
| O20100930030859 | O | Pharmacy | UT | 2025-07-31 |
| O20111206000335 | O | Mass Immunization (Roster Biller Only) | UT | TBD |
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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| G0008 | Administration of influenza virus vaccine | 314 | 311 | $0 |
| 90694 | Influenza vaccine, quadrivalent inactivated, 0.5 ml dosage | 295 | 295 | $0 |
| 91320 | Sarscv2 vac 30mcg trs-suc im | 241 | 241 | $0 |
| 90480 | Admn sarscov2 vacc 1 dose | 241 | 241 | $0 |
| G0009 | Administration of pneumococcal vaccine | 21 | 21 | $0 |
Insurance plans in this area (ZIP 84604)
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