MR. ETHAN D WASHBURN (PA-C) – Physician Assistant, NPI 1003142936

MR. ETHAN D WASHBURN (PA-C) is a healthcare provider. based in Moses lake, Washington. specializing in PHYSICIAN ASSISTANT. They hold the professional credentials PA-C. They hold a License No. PA60120190 (WA). The NPI Number for MR. ETHAN D WASHBURN (PA-C) is 1003142936

Main info

Male
17 Years Of Experience
Accepts Medicare Assignment
Name
MR. ETHAN D WASHBURN (PA-C)
NPI
1003142936
Phone
(509) 793-9715
Address
660 S COOLIDGE ST
Enumeration Date
28 October 2009
Last Update Date
21 November 2019

Doctor Profile

Medical School Name
OTHER
Secondary Phone
50948852568512
Graduation Year
2009 (17 years ago)
PAC ID
7911040753
Group Practice PAC ID
4486564309
Professional Enrollment ID
I20100202000832
Address ID
WA993441846OT1515XSTXX400
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience51
Completeness75
Years active:16State licenses:1Digital endpointsOther names

4,282 PHYSICIAN ASSISTANT in WA

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Provider Addresses for MR. ETHAN D WASHBURN (PA-C)

  • 660, South Coolidge Street, Moses Lake, Grant County, Washington, 98837, United States

    MOSES LAKE, WA 988371872

    Phone: (509) 793-9715

    Fax: (509) 764-3244

    Type: Mailing

  • 1550, South Pioneer Way, Moses Lake, Grant County, Washington, 98837, United States

    MOSES LAKE, WA 988374613

    Phone: (509) 793-9770

    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: 2010-02-02

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

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20100202000832IPhysician AssistantWATBD

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.

Verify on CMS Revalidation Lookup Tool

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 98837)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 4486564309View full group profile
NameSpecialtyState
-WA
Undefined Non Physician Type (Specify), Mental Health CounselorWA
Nurse PractitionerWA
Nurse PractitionerWA
Family PracticeWA
Physician AssistantWA
Physician AssistantWA
Nurse PractitionerWA
Physician AssistantWA
Nurse PractitionerWA

Reviews

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Frequently asked questions

What is MR. ETHAN D WASHBURN (PA-C)'s NPI number?
MR. ETHAN D WASHBURN (PA-C)'s NPI is 1003142936 — the number used across U.S. healthcare to identify this provider.
Is there an active status for MR. ETHAN D WASHBURN (PA-C)?
For scheduling context, MR. ETHAN D WASHBURN (PA-C) is shown as active in the registry.
How would a patient describe MR. ETHAN D WASHBURN (PA-C)'s focus?
For MR. ETHAN D WASHBURN (PA-C), the primary taxonomy reads as Physician Assistant. Clinical services aligned with this taxonomy classification.
Is MR. ETHAN D WASHBURN (PA-C) located near Moses Lake?
MR. ETHAN D WASHBURN (PA-C) currently maps to Moses Lake, Washington in this extract.
When was this NPI issued?
Enumeration for MR. ETHAN D WASHBURN (PA-C) is noted as October 28, 2009 where the registry provides it.

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