DOUGLAS EDISON WEST (PAC) – Physician Assistant, NPI 1104884295
Physician Assistant
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Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
4,282 PHYSICIAN ASSISTANT in WA
Provider Addresses for DOUGLAS EDISON WEST (PAC)
101 W 8th Ave
Spokane, WA 992042307
Phone: (509) 459-3583
Fax: (509) 482-1856
Type: Location
32, Liberty Drive, Valley Forge, Woodbury, Town of Woodbury, Orange, New York, 10930, United States
LIBERTY LAKE, WA 990190032
Phone: (509) 529-8905
Type: Mailing
301, West Poplar Street, Walla Walla, Walla Walla County, Washington, 99362, United States
STE 220
WALLA WALLA, WA 993622858
Phone: (509) 522-1030
Fax: (509) 529-6066
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: 2004-03-22
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 |
|---|---|---|---|---|
| I20040322001343 | I | Physician Assistant | WA | 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 |
|---|---|---|---|---|
| 99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | 33 | 33 | $0 |
| 99291 | Critical care, first 30-74 minutes | 13 | 13 | $0 |
| 99222 | Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes | 11 | 11 | $0 |
Insurance plans in this area (ZIP 99204)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| PHYSICIAN ASSISTANT | WA | 63048 | Partial removal of spine bone with release of spinal cord and/or nerves | 39 | 26 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| - | WA | |
| Internal Medicine | WA | |
| - | WA | |
| Physician Assistant | WA | |
| - | WA | |
| - | WA | |
| Physician Assistant | WA | |
| Internal Medicine | WA | |
| - | WA | |
| - | WA |
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