SUAH PARK – Medical-Surgical Registered Nurse, NPI 1316563091
Medical-Surgical Registered Nurse
Main info
Doctor Profile
Contacts
Profile Insights
NPPES metrics only — not quality of care.
6,261 NURSE PRACTITIONER in WA
Provider Addresses for SUAH PARK
5207 88TH STREET CT SW APT E207
LAKEWOOD, WA 984993176
Phone: (949) 304-8785
Type: Mailing
8725 S TACOMA WAY
LAKEWOOD, WA 984994544
Phone: (253) 535-5552
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 87 Open Payments records for all available years, with a total value of $1,766.
Total Amount is formed as General ($1,766) + Research ($0) + Ownership ($0) = $1,766.
Last reported payment date: 2024-12-13 • Largest payer in this snapshot: ABBVIE INC. ($783).
Total Amount
$1,766
General + Research + Ownership
Payments
87
Total payment records
General Amount
$1,766
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-13
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ABBVIE INC. | $783 |
| Orexo US, Inc. | $207 |
| AstraZeneca Pharmaceuticals LP | $124 |
| Lilly USA, LLC | $71 |
| Medtronic, Inc. | $67 |
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: 2021-02-24
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 |
|---|---|---|---|---|
| I20210224000193 | I | Nurse Practitioner | 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 98499)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Family Practice | WA |
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