HA TA (MD) – Internal Medicine Physician, NPI 1568437069
Internal Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
109 GENERAL PRACTICE in WA
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Provider Addresses for HA TA (MD)
1400, East Kincaid Street, Mount Vernon, Skagit County, Washington, 98274, United States
SKAGIT REGIONAL CLINICS, ATTN: CREDENTIALING
MOUNT VERNON, WA 982744127
Phone: (360) 428-2500
Fax: (360) 428-6485
Type: Mailing
1415, East Kincaid Street, Mount Vernon, Skagit County, Washington, 98274, United States
SKAGIT VALLEY HOSPITAL, HOSPITALISTS OFFICE
MOUNT VERNON, WA 982744126
Phone: (360) 416-5750
Fax: (360) 416-5758
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $112.
Total Amount is formed as General ($112) + Research ($0) + Ownership ($0) = $112.
Last reported payment date: 2024-10-23 • Largest payer in this snapshot: Phathom Pharmaceuticals, Inc. ($112).
Total Amount
$112
General + Research + Ownership
Payments
1
Total payment records
General Amount
$112
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-10-23
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Phathom Pharmaceuticals, Inc. | $112 |
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: 2012-11-20
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 |
|---|---|---|---|---|
| I20121120000566 | I | General Practice | 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 |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 135 | 86 | $0 |
| 99215 | Established patient office or other outpatient visit, 40-54 minutes | 84 | 56 | $0 |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 33 | 33 | $0 |
| 90694 | Influenza vaccine, quadrivalent inactivated, 0.5 ml dosage | 20 | 20 | $0 |
| G0008 | Administration of influenza virus vaccine | 20 | 20 | $0 |
Insurance plans in this area (ZIP 98274)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | UT | |
| - | WA | |
| Nurse Practitioner | WA | |
| Nurse Practitioner | WA | |
| Internal Medicine | WA |
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