NISSAN ARMAS (PA-C) – Physician Assistant, NPI 1083223291

NISSAN ARMAS (PA-C) is a healthcare provider. based in Shelton, Washington. specializing in FAMILY PRACTICE, PHYSICIAN ASSISTANT. They hold the professional credentials PA-C. They hold a License No. 1183036 (). The NPI Number for NISSAN ARMAS (PA-C) is 1083223291

Main info

Male
5 Years Of Experience
Accepts Medicare Assignment
Name
NISSAN ARMAS (PA-C)
NPI
1083223291
Phone
(360) 427-9006
Address
90 SE KLAH CHE MIN DR
Enumeration Date
24 July 2020
Last Update Date
21 November 2025

Doctor Profile

Medical School Name
UNIVERSITY OF NEVADA SCHOOL OF MEDICINE
Secondary Phone
3604279006
Graduation Year
2021 (5 years ago)
PAC ID
6901382621
Group Practice PAC ID
2860383122
Professional Enrollment ID
I20260113002185
Address ID
WA985849216SH90XXXDRXX600
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience34
Completeness85
Years active:5State licenses:1Digital endpointsOther names

2,660 FAMILY PRACTICE in CO

Provider Addresses for NISSAN ARMAS (PA-C)

  • 90 SE KLAH CHE MIN DR

    SHELTON, WA 985849216

    Phone: (360) 427-9006

    Type: Mailing

  • 4367 PRAIRIE ROSE CIR

    CASTLE ROCK, CO 801094557

    Phone: (915) 504-0957

    Type: Mailing

  • 1650 COCHRANE CIR

    COLORADO SPRINGS, CO 809134613

    Phone: (915) 504-0957

    Type: Location

  • 1772 BROWN AVE

    DUPONT, WA 983278794

    Phone: (915) 504-0957

    Type: Mailing

  • 9040 JACKSON AVE

    TACOMA, WA 984310001

    Phone: (915) 504-0957

    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: 2026-01-13

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
I20260113002185IPhysician 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 98584)

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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: 2860383122View full group profile
NameSpecialtyState
Family PracticeWA
Nurse PractitionerWA
Nurse PractitionerFL
-WA
Internal MedicineWA

Reviews

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Frequently asked questions

Can I cross-check NISSAN ARMAS (PA-C) using NPI 1083223291?
NPI 1083223291 belongs to NISSAN ARMAS (PA-C); compare other details if you need extra assurance.
Is NISSAN ARMAS (PA-C) still an active registrant?
NISSAN ARMAS (PA-C) carries an active NPI according to the public dataset.
What area of care is associated with NISSAN ARMAS (PA-C)?
NISSAN ARMAS (PA-C)'s record emphasizes Physician Assistant. Clinical services aligned with this taxonomy classification.
What practice footprint exists for NISSAN ARMAS (PA-C)?
Travel planning: use Shelton, Washington as the reference point for NISSAN ARMAS (PA-C), then confirm.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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