MR. TANNER JAMES VICK (PA-C) – Surgical Physician Assistant, NPI 1487632667
Surgical Physician Assistant
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Profile Insights
NPPES metrics only — not quality of care.
4,282 PHYSICIAN ASSISTANT in WA
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Provider Addresses for MR. TANNER JAMES VICK (PA-C)
3360, Southwest 87th Avenue, Raleigh West, Portland, Metro, Washington County, Oregon, 97225, United States
PROVIDENCE HEALTH & SERVICES
PORTLAND, OR 972083360
Phone: (866) 366-2983
Type: Mailing
1330, Rockefeller Avenue, Everett, Snohomish County, Washington, 98201, United States
STE 520
EVERETT, WA 982011684
Phone: (425) 297-5200
Fax: (425) 297-5210
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 7 Open Payments records for all available years, with a total value of $193.
Total Amount is formed as General ($193) + Research ($0) + Ownership ($0) = $193.
Last reported payment date: 2024-11-18 • Largest payer in this snapshot: Medtronic, Inc. ($82).
Total Amount
$193
General + Research + Ownership
Payments
7
Total payment records
General Amount
$193
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-18
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Medtronic, Inc. | $82 |
| W. L. Gore & Associates, Inc. | $74 |
| BIOTRONIK INC. | $19 |
| Integra LifeSciences Corporation | $18 |
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: 2005-01-03
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 |
|---|---|---|---|---|
| I20050103001012 | I | Physician Assistant | 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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 41 | 33 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 22 | 22 | $0 |
| 11042 | Removal of skin and tissue, 20.0 sq cm or less | 18 | 14 | $0 |
Insurance plans in this area (ZIP 97208)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| PHYSICIAN ASSISTANT | WA | 11042 | Removal of skin and tissue first 20 sq cm or less | 81 | 52 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Clinical Social Worker | WA | |
| - | WA | |
| - | WA | |
| - | WA | |
| - | OR | |
| - | WA | |
| - | WA | |
| - | WA | |
| - | WA | |
| Infectious Disease, Internal Medicine | WA |
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