NICOLE DIANNE WYDRA (PA-C) – Medical Physician Assistant, NPI 1962514836
Medical Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
2,876 PHYSICIAN ASSISTANT in OR
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Provider Addresses for NICOLE DIANNE WYDRA (PA-C)
1740, Northwest 9th Street, Corvallis, Benton County, Oregon, 97330, United States
CORVALLIS, OR 973302141
Phone:
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 205 Open Payments records for all available years, with a total value of $3,792.
Total Amount is formed as General ($3,792) + Research ($0) + Ownership ($0) = $3,792.
Last reported payment date: 2024-12-12 • Largest payer in this snapshot: ABBVIE INC. ($1,083).
Total Amount
$3,792
General + Research + Ownership
Payments
205
Total payment records
General Amount
$3,792
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-12
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ABBVIE INC. | $1,083 |
| Janssen Biotech, Inc. | $482 |
| Lilly USA, LLC | $411 |
| PFIZER INC. | $333 |
| E.R. Squibb & Sons, L.L.C. | $155 |
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: 2011-04-04
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 |
|---|---|---|---|---|
| I20110404000845 | 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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 17003 | Destruction of precancer skin growth, 2-14 growths | 405 | 128 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 258 | 230 | $0 |
| 17000 | Destruction of precancer skin growth, 1 growth | 221 | 192 | $0 |
| 99212 | Established patient office or other outpatient visit, 10-19 minutes | 182 | 162 | $0 |
| 17110 | Destruction of skin growth, 1-14 growths | 123 | 115 | $0 |
Insurance plans in this area (ZIP 97330)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| PHYSICIAN ASSISTANT | OR | 17003 | Destruction of 2-14 skin growths | 364 | 75 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| D E R M A T O L O G Y | OR | |
| D E R M A T O L O G Y | OR | |
| Physician Assistant | OR |
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