NORTHEASTERN UTAH MEDICAL GROUP – Family Medicine Physician, NPI 1982664199
Family Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for NORTHEASTERN UTAH MEDICAL GROUP
38080 West SR 35
Tabiona Clinic, UT 84072
Phone: (435) 848-5509
Fax: (435) 848-5507
Type: Location
475 N 500 W
Vernal, UT 840781907
Phone: (435) 781-2030
Type: Location
379 N 500 W
Vernal, UT 840781956
Phone: (435) 781-2030
Type: Location
175 N 200 W 102
Vernal, UT 84078
Phone: (435) 789-4489
Type: Location
50 E 200 S
Duchesne, UT 84021
Phone: (435) 738-2426
Fax: (435) 738-2845
Type: Location
96 North 100 West
Manila, UT 84046
Phone: (435) 784-3575
Fax: (435) 784-3505
Type: Location
15548 W 4000 W
Altamont, UT 84001
Phone: (435) 454-3173
Fax: (435) 454-3990
Type: Location
405 N 500 W
Vernal, UT 840781907
Phone: (435) 789-4691
Fax: (435) 722-9291
Type: Location
210 W 300 N
ROOSEVELT, UT 840662336
Phone: (435) 722-3971
Fax: (435) 722-6104
Type: Mailing
West 300 North, Roosevelt, Duchesne County, Utah, 84066, United States
ROOSEVELT, UT 84066
Phone: (435) 722-3971
Fax: (435) 722-6104
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: 2004-04-14
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 |
|---|---|---|---|---|
| O20040414000471 | 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 84072)
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Reviews
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