SHANETTE BRUCE OWEN – Family Medicine Physician, NPI 1629430228
Family Medicine Physician
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Profile Insights
NPPES metrics only — not quality of care.
4,141 FAMILY PRACTICE in WA
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Provider Addresses for SHANETTE BRUCE OWEN
Market Street Northeast, Salem, Marion County, Oregon, 97309, United States
SALEM, OR 973011826
Phone: (503) 910-4052
Type: Mailing
6351 W RIO GRANDE AVE
KENNEWICK, WA 993367634
Phone: (509) 543-9280
Fax: (509) 579-5915
Type: Mailing
1000, Wallace Way, Blacks Corner, Grandview, Yakima County, Washington, 98930, United States
GRANDVIEW, WA 989308805
Phone: (509) 882-3444
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 2 Open Payments records for all available years, with a total value of $179.
Total Amount is formed as General ($179) + Research ($0) + Ownership ($0) = $179.
Last reported payment date: 2024-09-26 • Largest payer in this snapshot: ABBVIE INC. ($103).
Total Amount
$179
General + Research + Ownership
Payments
2
Total payment records
General Amount
$179
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-09-26
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ABBVIE INC. | $103 |
| Dexcom, Inc. | $76 |
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: 2021-09-27
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 |
|---|---|---|---|---|
| I20210927001465 | I | Family Practice | 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 97301)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | WA | |
| Internal Medicine | WA | |
| - | WA | |
| - | WA | |
| Family Practice | WA | |
| Mental Health Counselor | WA | |
| Family Practice | WA | |
| Family Practice | WA | |
| Mental Health Counselor | WA | |
| Internal Medicine | WA |
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