SETH M GRISHAM (PA-C) – Medical Physician Assistant, NPI 1710402540
Medical Physician Assistant
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Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for SETH M GRISHAM (PA-C)
972 N 600 E
Spanish Fork, UT 846601306
Phone: (801) 465-4896
Type: Location
29043, 19th Avenue South, Marine Hills, Federal Way, King County, Washington, 98003, United States
FEDERAL WAY, WA 980033872
Phone: (253) 951-1200
Type: Mailing
1300, Northeast Goldie Street, Oak Harbor, Island County, Washington, 97277, United States
OAK HARBOR, WA 982774832
Phone: (360) 679-5590
Type: Location
1055 N 500 W
ATTN CREDENTIALING
PROVO, UT 846043305
Phone: (801) 354-8225
Type: Mailing
555 W STATE ROAD 164
SALEM, UT 846535732
Phone: (801) 465-4896
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
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: 2022-05-10
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 |
|---|---|---|---|---|
| I20220510002364 | I | Physician Assistant | UT | 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 84660)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | WA | |
| - | WA | |
| Clinical Social Worker | WA | |
| Diagnostic Radiology, Interventional Radiology | WA | |
| Diagnostic Radiology | AK | |
| Physician Assistant | TN | |
| Nurse Practitioner | FL | |
| Nurse Practitioner | CO | |
| Emergency Medicine | WA | |
| Nurse Practitioner | WA |
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