JENNIFER A CASTELLUCCIO (PAC) – Physician Assistant, NPI 1679561435
Physician Assistant
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Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for JENNIFER A CASTELLUCCIO (PAC)
PO BOX 34876
SEATTLE, WA 981241876
Phone: (425) 656-5412
Fax: (425) 656-5096
Type: Mailing
3600 LIND AVE SW
SUITE 100 ATTN CREDENTIALING
RENTON, WA 980574970
Phone: (425) 690-2715
Type: Mailing
Valley Medical Center - Maple Valley Clinic, 26458, Maple Valley Black Diamond Road Southeast, Danville, Maple Valley, King County, Washington, 98038, United States
MAPLE VALLEY, WA 98038
Phone: (425) 690-3460
Fax: (425) 690-9460
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: 2009-07-10
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 |
|---|---|---|---|---|
| I20090710000115 | 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 98124)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Family Practice | WA | |
| Physical Therapist In Private Practice | WA | |
| Internal Medicine, Hospitalist | WA | |
| P S Y C H I A T R Y | WA | |
| Hospice/Palliative Care, Internal Medicine | WA | |
| Internal Medicine, Hospitalist | CA | |
| Family Practice | WA | |
| Family Practice, Emergency Medicine | WA | |
| - | WA | |
| - | WA |
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