ABLAJAN HEYTAK (PA) – Physician Assistant, NPI 1174117907

Physician Assistant

ABLAJAN HEYTAK (PA) is a healthcare provider. based in Grand coulee, Washington. specializing in PHYSICIAN ASSISTANT. They hold the professional credentials PA. They hold a License No. PA61260172 (WA). The NPI Number for ABLAJAN HEYTAK (PA) is 1174117907

Main info

Male

15 Years Of Experience

Accepts Medicare Assignment

Name

ABLAJAN HEYTAK (PA)

NPI

1174117907

Phone

(509) 633-1911

Address

411 FORTUYN RD

Enumeration Date

23 February 2021

Last Update Date

26 October 2023

Doctor Profile

Medical School Name

OTHER

Secondary Phone

7183218246

Graduation Year

2011 (15 years ago)

PAC ID

0345641890

Group Practice PAC ID

1951456847

Professional Enrollment ID

I20210622002510

Address ID

NY113545536FL13640AVEX305

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience43

Completeness75

Years active:5State licenses:2Digital endpointsOther names

4,282 PHYSICIAN ASSISTANT in WA

Provider Addresses for ABLAJAN HEYTAK (PA)

411 FORTUYN RD
GRAND COULEE, WA 991338718
Phone: (509) 633-1911
Fax: (509) 633-3644
Type: Mailing
PO BOX 2625
NEW YORK, NY 100098925
Phone: (718) 321-8246
Fax: (718) 321-8273
Type: Mailing
13640 39TH AVE STE 6GB
FLUSHING, NY 113545536
Phone: (718) 321-8246
Fax: (718) 321-8273
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: 2022-02-23

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking 2 Medicare enrollment records; no due dates published yet.

Enrollment records

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
I20210622002510	I	Physician Assistant	NY	TBD
I20220223002075	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.

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 99133)

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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: 1951456847View full group profile