PUEBLO MEDICAL IMAGING, LLC – Diagnostic Radiology Physician, NPI 1952353591
Diagnostic Radiology Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Loading map...
Provider Addresses for PUEBLO MEDICAL IMAGING, LLC
PO BOX 30077
DEPT 306
SALT LAKE CITY, UT 841300077
Phone: (702) 228-0031
Type: Mailing
South Rainbow Boulevard, Charleston Heights, Las Vegas, Clark County, Nevada, 89146-1126, United States
LAS VEGAS, NV 891181872
Phone: (702) 228-0031
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.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2025-09-02
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 10 Medicare enrollment records; no due dates published yet.
Enrollment records
10
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 |
|---|---|---|---|---|
| O20040225000547 | O | Clinic/Group Practice | NV | TBD |
| O20230207003292 | O | Clinic/Group Practice | TX | TBD |
| O20230208000720 | O | Clinic/Group Practice | FL | TBD |
| O20230405001093 | O | Clinic/Group Practice | OK | TBD |
| O20230912003226 | O | Clinic/Group Practice | VA | TBD |
| O20241003000790 | O | Clinic/Group Practice | NY | TBD |
| O20241120004709 | O | Clinic/Group Practice | CA | TBD |
| O20250122000619 | O | Clinic/Group Practice | TN | TBD |
| O20250606000821 | O | Clinic/Group Practice | OH | TBD |
| O20250902000165 | O | Clinic/Group Practice | DC | 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)
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.