KETCHIKAN MEDICAL CENTER – Diagnostic Radiology Physician, NPI 1801965736
Diagnostic Radiology Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for KETCHIKAN MEDICAL CENTER
Peace Health Ketchikan Medical Ceneter, 3100, Tongass Avenue, Ketchikan, Ketchikan Gateway, Alaska, 99901, United States
KETCHIKAN, AK 999015746
Phone: (907) 228-8300
Fax: (907) 228-8518
Type: Location
Bellingham Post Office, Rolling Hills Drive, Bellingham, Norfolk County, Massachusetts, 02019, United States
BELLINGHAM, WA 982271798
Phone: (360) 734-5400
Fax: (360) 715-6552
Type: Mailing
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: 2025-12-03
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 15 Medicare enrollment records; no due dates published yet.
Enrollment records
15
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 |
|---|---|---|---|---|
| O20031106000460 | O | Clinic/Group Practice | AK | TBD |
| O20250918000998 | O | Clinic/Group Practice | NY | TBD |
| O20250923000534 | O | Clinic/Group Practice | TX | TBD |
| O20250925001718 | O | Clinic/Group Practice | IA | TBD |
| O20250926001128 | O | Clinic/Group Practice | GA | TBD |
| O20251002004590 | O | Clinic/Group Practice | OR | TBD |
| O20251015000533 | O | Clinic/Group Practice | NC | TBD |
| O20251021001844 | O | Clinic/Group Practice | NM | TBD |
| O20251029002199 | O | Clinic/Group Practice | IN | TBD |
| O20251031000055 | O | Clinic/Group Practice | FL | TBD |
| O20251105001287 | O | Clinic/Group Practice | CO | TBD |
| O20251106000203 | O | Clinic/Group Practice | PA | TBD |
| O20251107000070 | O | Clinic/Group Practice | TN | TBD |
| O20251125002484 | O | Clinic/Group Practice | OH | TBD |
| O20251203000267 | O | Clinic/Group Practice | CA | 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 99901)
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