Intermountain Healthcare Core Laboratory – Clinical Medical Laboratory, NPI 1720029960
Clinical Medical Laboratory
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Intermountain Healthcare Core Laboratory
4646, Lake Park Boulevard, West Valley City, Salt Lake County, Utah, 84120, United States
SALT LAKE CITY, UT 841208212
Phone:
Type: Mailing
5252 SOUTH, INTERMOUNTAIN DRIVE
MURRAY, UT 84107
Phone: (801) 507-2350
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: 2004-01-19
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 |
|---|---|---|---|---|
| O20040119000317 | O | Independent Clinical Laboratory | 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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 36415 | Insertion of needle into vein for collection of blood sample | 35,639 | 19,948 | $0 |
| 80053 | Blood test, comprehensive group of blood chemicals | 23,421 | 16,773 | $0 |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | 18,430 | 12,124 | $0 |
| 80061 | Blood test, lipids (cholesterol and triglycerides) | 15,364 | 14,132 | $0 |
| 84443 | Blood test, thyroid stimulating hormone (tsh) | 11,618 | 9,596 | $0 |
Insurance plans in this area (ZIP 84120)
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