SAMANTHA B BRUNNER (PA-C) – Physician Assistant, NPI 1639451750

SAMANTHA B BRUNNER (PA-C) is a healthcare provider. based in Grand coulee, Washington. specializing in PHYSICIAN ASSISTANT. They hold the professional credentials PA-C. They hold a License No. PA60233756 (WA). The NPI Number for SAMANTHA B BRUNNER (PA-C) is 1639451750

Main info

Female
15 Years Of Experience
Accepts Medicare Assignment
Name
SAMANTHA B BRUNNER (PA-C)
NPI
1639451750
Phone
(509) 633-1911
Address
411 FORTUYN RD
Enumeration Date
14 September 2011
Last Update Date
1 October 2020

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3608822778
Graduation Year
2011 (15 years ago)
PAC ID
3577737832
Group Practice PAC ID
3173436490
Professional Enrollment ID
I20111122000870
Address ID
WA986849542VA501XXAVEX400
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience57
Completeness75
Years active:14State licenses:1Digital endpointsOther names

4,282 PHYSICIAN ASSISTANT in WA

Provider Addresses for SAMANTHA B BRUNNER (PA-C)

  • 411 FORTUYN RD

    GRAND COULEE, WA 991338718

    Phone: (509) 633-1911

    Fax: (509) 633-3644

    Mailing address matches the actual address.

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: 2011-11-22

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

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20111122000870IPhysician AssistantWATBD

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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99232Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes2011$0
View full utilization report →

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: 3173436490View full group profile
NameSpecialtyState
Physician AssistantTN
Internal Medicine, Infectious DiseasePA
Internal MedicineWA
Diagnostic RadiologyOR
Internal MedicineOR
O P H T H A L M O L O G YIA
-OR
Nurse PractitionerWA
Nurse PractitionerWA
Interventional Cardiology, Cardiovascular Disease (Cardiology)CA

Reviews

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Frequently asked questions

Does SAMANTHA B BRUNNER (PA-C) have a public NPI I can cite?
Public records show SAMANTHA B BRUNNER (PA-C) under NPI 1639451750.
Does the public listing show SAMANTHA B BRUNNER (PA-C) as active?
SAMANTHA B BRUNNER (PA-C)'s NPI record reflects an active status in NPPES.
How should patients interpret SAMANTHA B BRUNNER (PA-C)'s specialty?
The extract shows Physician Assistant for SAMANTHA B BRUNNER (PA-C). Clinical services aligned with this taxonomy classification.
What geographic area is tied to SAMANTHA B BRUNNER (PA-C)?
SAMANTHA B BRUNNER (PA-C) is associated with Grand Coulee, Washington in the same public data insurers reference.
Can I verify credentials using only NPI?
NPI confirms identity in the directory; licensure and board certification require separate checks.

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