FREDRICK SUNGJAE AN (DO) – Internal Medicine Physician, NPI 1194991901
Internal Medicine Physician
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Profile Insights
NPPES metrics only — not quality of care.
2,474 INTERNAL MEDICINE in OR
Provider Addresses for FREDRICK SUNGJAE AN (DO)
24800 SE Stark St
Gresham, OR 970303378
Phone: (503) 413-8407
Type: Location
1717 S J St
Tacoma, WA 984054933
Phone: (253) 426-6341
Fax: (253) 426-6344
Type: Location
413 LILLY RD NE
OLYMPIA, WA 985065166
Phone: (360) 491-9480
Fax: (360) 456-2413
Type: Mailing
Legacy Mount Hood Medical Center, 24800, Southeast Stark Street, Gresham, Metro, Multnomah County, Oregon, 97030, United States
GRESHAM, OR 970303378
Phone: (503) 413-8407
Type: Mailing
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: 2025-03-03
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 |
|---|---|---|---|---|
| I20250303001704 | I | Internal Medicine | WA | 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 97030)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | WA | |
| - | WA | |
| Family Practice | WA | |
| - | WA | |
| - | OH | |
| O P H T H A L M O L O G Y | WA | |
| Family Practice | WI | |
| Internal Medicine | OR | |
| Clinical Social Worker | WA | |
| - | WA |
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