MICHELLE M LYDSTON (PA-C) – Physician Assistant, NPI 1194746222
Physician Assistant
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Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for MICHELLE M LYDSTON (PA-C)
8301 161st Ave NE
Suite 105
Redmond, WA 980523858
Phone: (425) 883-3333
Fax: (425) 869-4854
Type: Location
19200 N Kelsey St
Monroe, WA 982721431
Phone: (360) 794-7994
Fax: (425) 259-8600
Type: Location
3360, Southwest 87th Avenue, Raleigh West, Portland, Metro, Washington County, Oregon, 97225, United States
PORTLAND, OR 972083360
Phone: (866) 747-2455
Type: Mailing
12800, Bothell-Everett Highway, Everett, Snohomish County, Washington, 98208, United States
EVERETT, WA 98208
Phone: (425) 316-5150
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: 2005-10-08
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 |
|---|---|---|---|---|
| I20051008000262 | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 98052)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | WA | |
| - | WA | |
| - | WA | |
| Interventional Cardiology, Cardiovascular Disease (Cardiology) | WA | |
| Physician Assistant | WY | |
| - | WA | |
| Nurse Practitioner | WA | |
| Physician Assistant | WV | |
| Family Practice | VT | |
| - | WA |
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