ANDREW TISTADT (PA-C) – Physician Assistant, NPI 1831269265
Physician Assistant
Main info
Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
2,876 PHYSICIAN ASSISTANT in OR
Provider Addresses for ANDREW TISTADT (PA-C)
3158, Southwest 87th Avenue, Portland, Metro, Washington County, Oregon, 97225, United States
PORTLAND, OR 972083158
Phone:
Type: Mailing
18040 SW LOWER BOONES FERRY RD STE 304
TIGARD, OR 972247258
Phone: (503) 216-0700
Type: Location
PO BOX 6149
ALOHA, OR 970070149
Phone: (503) 352-8657
Fax: (503) 352-8658
Type: Mailing
21810 WILLAMETTE DR STE 200
WEST LINN, OR 970683287
Phone: (503) 994-4353
Fax: (503) 722-5100
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $46.
Total Amount is formed as General ($46) + Research ($0) + Ownership ($0) = $46.
Last reported payment date: 2024-05-20 • Largest payer in this snapshot: Genentech USA, Inc. ($46).
Total Amount
$46
General + Research + Ownership
Payments
1
Total payment records
General Amount
$46
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-05-20
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Genentech USA, Inc. | $46 |
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: 2007-01-08
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 |
|---|---|---|---|---|
| I20070108000520 | 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 97208)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Clinical Psychologist | OR | |
| Internal Medicine, Pediatric Medicine | OR | |
| Internal Medicine | MA |
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