CARL WALLACE LEDER (PA-C) – Physician Assistant, NPI 1619341724
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for CARL WALLACE LEDER (PA-C)
865 8TH ST
GERVAIS, OR 970269757
Phone: (208) 419-6003
Type: Mailing
1375 N 10TH AVE
STAYTON, OR 973832099
Phone: (503) 769-2641
Type: Location
PO BOX 1121
ROSEBURG, OR 974700254
Phone: (541) 672-2691
Fax: (833) 299-8415
Type: Mailing
621 W MADRONE ST
ROSEBURG, OR 974703090
Phone: (541) 672-2691
Fax: (833) 299-8415
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 15 Open Payments records for all available years, with a total value of $299.
Total Amount is formed as General ($299) + Research ($0) + Ownership ($0) = $299.
Last reported payment date: 2024-06-12 • Largest payer in this snapshot: ABBVIE INC. ($91).
Total Amount
$299
General + Research + Ownership
Payments
15
Total payment records
General Amount
$299
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-06-12
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ABBVIE INC. | $91 |
| Axsome Therapeutics, Inc. | $48 |
| GlaxoSmithKline, LLC. | $35 |
| PFIZER INC. | $31 |
| Novo Nordisk Inc | $25 |
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: 2016-01-19
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 |
|---|---|---|---|---|
| I20160119000476 | I | Physician Assistant | OR | 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 97026)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Clinical Social Worker | OR | |
| Mental Health Counselor | OR | |
| Physician Assistant | OR | |
| Nurse Practitioner | OR | |
| Nurse Practitioner | NE | |
| P S Y C H I A T R Y | ID | |
| - | WA | |
| Nurse Practitioner | CA | |
| - | OR | |
| Nurse Practitioner | OR |
Reviews
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