JENNIFER EVANS TIDROSKI D.O. - NPI 1639457245

Q: What is Jennifer Tidroski's NPI number?

The NPI number for Jennifer Tidroski is 1639457245. It was assigned to this individual provider in the NPPES registry on July 31, 2011.

Q: What is Jennifer Tidroski's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Q: Is Jennifer Tidroski enrolled in Medicare?

No. Jennifer Tidroski has opted out of Medicare through April 1, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

Q: When was this NPI record last updated?

The NPPES record for Jennifer Tidroski was last updated on February 21, 2017. NPI Profile syncs with the weekly NPPES data releases published by CMS.

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About Jennifer Evans Tidroski D.o. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JENNIFER EVANS TIDROSKI D.O. (NPI 1639457245) is an individual pediatrics provider in Prescott, Arizona, licensed in Arizona (007047) and active in the NPI registry since July 2011. She has opted out of Medicare through April 1, 2028 and remains eligible to order and refer.

NPPES Registry Identity

NPI1639457245

Entity TypeIndividualFemale

Primary Taxonomy208000000X

Provider Legal NameJENNIFER EVANS TIDROSKICredential: D.O.

Location Address2120 CENTERPOINTE WEST DRPrescott, AZ 86301-8487

Mailing AddressPo Box 10880Prescott, AZ 86304-0880 · (928) 759-5874 · Fax (928) 458-2039

Phone(928) 778-4581

Fax(928) 776-1872

Sole ProprietorNo

Enumeration DateJuly 31, 2011

Last NPPES UpdateFebruary 21, 20172 updates tracked since enumeration

✔ NPI 1639457245 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians

Taxonomy Code208000000X

Licenses✔ Licensed in AZ · 007047✔ Licensed in TX · P0309

Definition

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

2120 CENTERPOINTE WEST DR, Prescott, AZ 86301

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Other Identifiers 3

Medicare UPINZ194390AZ

Medicaid2865081TX

Medicaid182372AZ

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Jennifer Evans Tidroski D.o. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from April 1, 2026 through April 1, 2028.

Opt-Out Effective DateApril 1, 2026

Opt-Out In Effect ThroughApril 1, 2028Opt-out affidavits renew automatically every two years unless cancelled

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 86301 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$85.89 typical visit price

range $55.44 – $168.60

Typical copayment $21.47 (range $13.86 – $42.15)

Most-billed visit code 99203

Established Patient

$98.00 typical visit price

range $17.72 – $137.41

Typical copayment $24.50 (range $4.43 – $34.35)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 9

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KETURAH LEGLER CPNP

Nurse Practitioner