SAMUEL DOUGLASS (DO) – Diagnostic Radiology Physician, NPI 1063801678
Diagnostic Radiology Physician
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NPPES metrics only — not quality of care.
1,262 DIAGNOSTIC RADIOLOGY in WA
Provider Addresses for SAMUEL DOUGLASS (DO)
9040 Fitzsimmons Dr
Joint Base Lewis McChord, WA 984311000
Phone: (253) 968-0369
Type: Location
300 W Hospital Rd
Fort Gordon, GA 309055741
Phone: (706) 787-2175
Type: Location
1304 Fawcett Ave Ste 100
Tacoma, WA 984021900
Phone: (253) 761-4200
Type: Location
877 W MAIN ST STE 603
BOISE, ID 837026070
Phone: (208) 954-8070
Fax: (208) 954-8073
Type: Mailing
9040 FITZSIMMONS DR
JOINT BASE LEWIS MCCHORD, WA 984311000
Phone: (253) 968-0369
Type: Mailing
300 W HOSPITAL RD
FORT GORDON, GA 309055741
Phone: (706) 787-2175
Type: Location
1055 N CURTIS RD
BOISE, ID 837061309
Phone: (208) 367-2121
Fax: (706) 596-6720
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: 2025-05-06
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 4 Medicare enrollment records; no due dates published yet.
Enrollment records
4
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 |
|---|---|---|---|---|
| I20230228001448 | I | Diagnostic Radiology | CO | TBD |
| I20240712002972 | I | Diagnostic Radiology | UT | TBD |
| I20250501002532 | I | Diagnostic Radiology | OR | TBD |
| I20250506002959 | I | Diagnostic Radiology | ID | 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 |
|---|---|---|---|---|
| 71046 | X-ray of chest, 2 views | 100 | 99 | $0 |
| 71250 | Ct scan of chest without contrast | 61 | 60 | $0 |
| 71271 | Low dose ct scan of chest for lung cancer screening | 39 | 39 | $0 |
| 73030 | X-ray of shoulder, minimum of 2 views | 32 | 30 | $0 |
| 72100 | X-ray of lower and sacral spine, 2-3 views | 31 | 31 | $0 |
Insurance plans in this area (ZIP 98431)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | UT | |
| - | UT | |
| Emergency Medicine | CO | |
| - | UT | |
| A N E S T H E S I O L O G Y | UT | |
| Physician Assistant | UT | |
| - | IL | |
| Plastic And Reconstructive Surgery | OH | |
| Physician Assistant | CA | |
| A N E S T H E S I O L O G Y | UT |
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