DR. BLAKE COOPER CORCORAN (M.D.) – Sports Medicine (Family Medicine) Physician, NPI 1235490038
Sports Medicine (Family Medicine) Physician
Main info
Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
188 SPORTS MEDICINE in WA
Provider Addresses for DR. BLAKE COOPER CORCORAN (M.D.)
1125 SE WASHINGTON ST.
PULLMAN, WA 99164
Phone: (509) 335-3575
Fax: (509) 335-6223
Type: Mailing
PO BOX 1189
CORVALLIS, OR 973391189
Phone:
Type: Mailing
675 N 5TH ST
LEBANON, OR 973552875
Phone: (541) 451-6282
Type: Location
1125 SE Washington St.
Pullman, WA 99164
Phone: (509) 335-3575
Fax: (509) 335-6223
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: 2024-12-04
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
2
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 |
|---|---|---|---|---|
| I20240613001968 | I | Family Practice | WA | TBD |
| I20241204004582 | I | Sports Medicine | OR | 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 99164)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | OR | |
| Physical Therapist In Private Practice | MT | |
| P S Y C H I A T R Y | OR | |
| Physician Assistant | OR | |
| - | OR | |
| - | OR | |
| Occupational Therapist In Private Practice | OR | |
| - | OR | |
| O B S T E T R I C S/ G Y N E C O L O G Y | PA | |
| - | OR |
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