MS. GRACE SUYANTI MULIAWAN (PA-C) – Physician Assistant, NPI 1649879081
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,534 PHYSICIAN ASSISTANT in ID
Provider Addresses for MS. GRACE SUYANTI MULIAWAN (PA-C)
3815 N SCHREIBER WAY STE 101
COEUR D ALENE, ID 838158362
Phone: (208) 755-2804
Fax: (208) 765-0277
Type: Mailing
980 W IRONWOOD DR STE 207
COEUR D ALENE, ID 838142668
Phone: (208) 755-2804
Fax: (208) 765-0277
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 265 Open Payments records for all available years, with a total value of $6,726.
Total Amount is formed as General ($6,726) + Research ($0) + Ownership ($0) = $6,726.
Last reported payment date: 2024-11-13 • Largest payer in this snapshot: Myriad Genetic Laboratories, Inc. ($592).
Total Amount
$6,726
General + Research + Ownership
Payments
265
Total payment records
General Amount
$6,726
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-13
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Myriad Genetic Laboratories, Inc. | $592 |
| Janssen Biotech, Inc. | $521 |
| PFIZER INC. | $430 |
| Novartis Pharmaceuticals Corporation | $359 |
| AstraZeneca Pharmaceuticals LP | $319 |
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: 2021-02-25
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 |
|---|---|---|---|---|
| I20210225002343 | I | Physician Assistant | ID | 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 83815)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Clinical Social Worker | ID | |
| Family Practice | ID | |
| Family Practice | OR | |
| Physician Assistant | ID | |
| Physician Assistant | ID | |
| Mental Health Counselor | ID | |
| Physician Assistant | ID |
Reviews
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